Corticosteroid treatment for early acute respiratory distress syndrome: a systematic review and meta-analysis of randomized trials

Table 1 Summary of findings

Outcomes	Anticipated absolute effects (95% CI)		Relative effect (OR (95% CI))	No. of participants (no. of studies)	Certainty of evidence (GRADE)
Outcomes	Control	Risk difference with corticosteroids	Relative effect (OR (95% CI))	No. of participants (no. of studies)	Certainty of evidence (GRADE)
All-cause 28- or 30-day mortality	389 per 1000	109 fewer per 1000 (170 fewer to 38 fewer)	0.61 (044–0.85)	742 (4 RCTs)	Moderate^a
All-cause 60-day mortality	381 per 1000	121 fewer per 1000 (183 fewer to 43 fewer)	0.57 (040–0.83)	565 (3 RCTs)	Moderate^a
Ventilator-free days at 28 days		MD 3.74 more (1.53 more to 5.95 more)		742 (4 RCTs)	Low^a,b
PaO₂/FiO₂ at days 6 or 7		MD 54.22 more (33.5 more to 74.93 more)		494 (3 RCTs)	Very low^a,c
Hyperglycemia	687 per 1000	82 more per 1000 (8 more to 142 more)	1.52 (1.04–2.21)	565 (3 RCTs)	Moderate^a
Nosocomial infections	232 per 1000	28 fewer per 1000 (81 fewer to 36 more)	0.85 (0.59–1.21)	742 (4 RCTs)	Low^a,d
Gastrointestinal bleeding	31 per 1000	12 more per 1000 (19 fewer to 110 more)	1.39 (0.38–5.06)	374 (2 RCTs)	Low^a,d

Grades of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group:
High certainty—We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty—We are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty—Our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect
Very low certainty—We have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of the effect
PaO₂ partial pressure of oxygen in arterial blood, FiO₂ fraction of inspired oxygen
^aDifferent types of corticosteroids and treatment regimens among studies were regarded as indirectness of evidence. Downgraded by 1
^bHeterogeneity observed among the studies (I² = 61.0%, χ² = 7.65, p = 0.05) was regarded as inconsistency of evidence. Downgraded by 1
^cHeterogeneity observed among the studies (I² = 93.0%, χ² = 26.75, p < 0.001) was regarded as inconsistency of evidence. Downgraded by 1
^dImprecision was observed among the studies. Downgraded by 1

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