Weekly Respiratory Research Analysis
This week’s respiratory literature highlights three high-impact findings: a biomarker-guided individual patient meta-analysis shows adjunctive corticosteroids reduce 30‑day mortality in hospitalized community‑acquired pneumonia patients with high baseline CRP; a large LMIC-focused meta-analysis quantifies a high burden of hypoxaemia across ages and links hypoxaemia to markedly increased mortality, underscoring oxygen system priorities; and real‑world test‑negative data support strong effectivene
Summary
This week’s respiratory literature highlights three high-impact findings: a biomarker-guided individual patient meta-analysis shows adjunctive corticosteroids reduce 30‑day mortality in hospitalized community‑acquired pneumonia patients with high baseline CRP; a large LMIC-focused meta-analysis quantifies a high burden of hypoxaemia across ages and links hypoxaemia to markedly increased mortality, underscoring oxygen system priorities; and real‑world test‑negative data support strong effectiveness of nirsevimab against RSV presentations to pediatric emergency departments. Collectively these studies push biomarker‑driven treatment, health‑system oxygen scale‑up, and infant RSV prevention toward near‑term implementation.
Selected Articles
1. Predicting benefit from adjuvant therapy with corticosteroids in community-acquired pneumonia: a data-driven analysis of randomised trials.
An individual patient data meta‑analysis of eight RCTs (n=3,224) found adjunctive corticosteroids reduce 30‑day mortality in hospitalized community‑acquired pneumonia (OR 0.72). Effect heterogeneity was driven by baseline CRP: patients with CRP >204 mg/L had substantial mortality benefit, whereas those with CRP ≤204 mg/L showed no significant effect.
Impact: Offers a validated biomarker (CRP) for targeting corticosteroids in CAP, resolving prior conflicting trial results and enabling more precise, potentially life‑saving therapy while avoiding unnecessary steroid exposure.
Clinical Implications: Integrate baseline CRP measurement into hospital CAP pathways and consider adjunctive corticosteroids for patients with CRP >204 mg/L; avoid routine use in low‑CRP patients and monitor steroid‑related adverse events.
Key Findings
- Across eight RCTs (n=3,224) corticosteroids reduced 30‑day all‑cause mortality (OR 0.72).
- Effect‑modelling identified baseline CRP as the key predictor: CRP >204 mg/L subgroup showed a large mortality reduction, CRP ≤204 mg/L showed no benefit.
2. The prevalence of hypoxaemia in paediatric and adult patients in health-care facilities in low-income and middle-income countries: a systematic review and meta-analysis.
A systematic review/meta‑analysis of 213 studies (601,757 participants) in LMICs estimated pooled hypoxaemia prevalence of 24.5% in neonates, 12.1% in children, and 10.8% in adults, and found hypoxaemia associated with a 4.84‑fold increase in odds of death. The study quantifies the cross‑age burden and prognostic significance of hypoxaemia, guiding oxygen system planning.
Impact: Robust cross‑age quantification of hypoxaemia and its strong link to mortality provides high‑priority evidence to accelerate pulse oximetry rollout, oxygen supply investments, and triage protocols in LMICs.
Clinical Implications: Prioritize pulse oximetry screening at all care levels, invest in reliable oxygen delivery systems, define context‑specific SpO2 thresholds, and include hypoxaemia metrics in quality‑of‑care indicators.
Key Findings
- Pooled hypoxaemia prevalence in LMICs: neonates 24.5%, children 12.1%, adults 10.8%.
- Hypoxaemia associated with 4.84‑fold higher odds of death across studies.
3. Nirsevimab effectiveness on paediatric emergency visits for RSV bronchiolitis: a test-negative design study.
A multicenter test‑negative study in five French university hospitals (n=383 infants with first bronchiolitis) found adjusted effectiveness of nirsevimab of 82.5% (95% CI 68.0–90.8) against RSV‑positive pediatric emergency presentations. Sensitivity analyses were consistent and short‑term outcomes at 15 days were similar.
Impact: Provides timely real‑world effectiveness evidence supporting national rollout of nirsevimab for infants and the expected near‑term reduction in pediatric ED burden from RSV.
Clinical Implications: Health systems should plan for broad seasonal nirsevimab deployment, anticipate reduced RSV ED presentations and hospitalizations, and monitor uptake and equity across populations.
Key Findings
- Multicenter test‑negative study (383 infants) with 274 RSV‑positive cases.
- Adjusted effectiveness at PEDs: 82.5% (95% CI 68.0–90.8).