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https://first10em.com/research-roundup-july-2023/
"my plan is to use steroids in patients with severe community acquired pneumonia going to the ICU who look like the CAPE-COD patients"
One of the more interesting articles review on this Paper Of The Month edition
By @first10em
#FOAMed #emergencymedicine #FOAMcc #emergencyphysician
Excellent post indeed. This one too
https://emcrit.org/pulmcrit/cape-cod/
Interestingly, patient with CRP > 150 mg/L seems to benefits the most of steroid. Selecting patient according to CRP might help ? (This seems obvious I know but still, sometimes forgotten?)
@matdesgro @first10em
Yes, really interesting as @PulmCrit posts as usual.
The only pitfall imho is that crp>150 doesn't mean "sick patient" by definition.
In sickest patients, crp could be a good trigger for steroids (no contraindications present) but the sine qua non condition seems to be "really unwell patient" more and before than any lab value.
Again (considering the rollercoaster aspect of this debate) just my opinion
@pietro87 @first10em @PulmCrit
Good point. Totally agree, labs are para-clinical points in the bigger clinical picture. We treat patients not numbers.
The key is to spot the patient with an inflammatory response. These are the patients who will benefit the most I think imho. Labs can help on this but will never substitute to clinical judgement. We don’t do LabCriticalCare 
Steroid debate is an endless debate I’m afraid
@matdesgro @pietro87 @first10em I don’t think we can conclude that from this data, to me it looks like simply the sub 150 group is too small and leads to a very imprecise estimate.
@load_dependent @pietro87 @first10em good point. The 95IC is large weakening any conclusion (without saying it’s a subgroup analysis) We need bigger groups & this signal needs further investigation.
The lab value doesn’t really matter imho. I think it’s the inflammatory patient who might benefit the most. The question is how identify this patient ?
@matdesgro @pietro87 @first10em Agree that it’s a plausible hypothesis, just not much evidence for or against it in this data.
Needs a bigger study, and looking at interaction using splines rather than arbitrary dichotomous cutoffs I think.
@matdesgro @pietro87 @first10em Though if there is an interaction, it is likely in the direvtion of higher CRP being associated with more positive effect.
@load_dependent @pietro87 @first10em wow ! very nice stats crunch !
That’s consistent indeed with an elevated inflammatory state that could predict a positive response. Agreed we need more info on the CRP level, from what value it is significant ?
Love to see this important question answered!