Torres 2015

Methods	Randomized controlled trial with 2 parallel groups 3 centres
Participants	Adults (n = 61) with both severe CAP and high inflammatory response, defined as levels of C‐reactive protein > 15 mg/dL on admission
Interventions	Methlyprednisolone (intravenous bolus of 0.5 mg/kg/12 h for 5 days started within 36 hours of hospital admission) Placebo (normal saline)
Outcomes	PRIMARY Rate of treatment failure, which includes early and/or late treatment failure. Early treatment failure was defined as clinical deterioration within 72 hours of treatment, as indicated by development of shock or need for invasive mechanical ventilation not present at baseline, or death. Late treatment failure was defined as radiographic progression (increase of ≥ 50% of pulmonary infiltrates compared with baseline), persistence of severe respiratory failure (PaO2/FiO2 < 200, with respiratory rate ≥ 30 min‐1 in non‐intubated participants), development of shock or need for invasive mechanical ventilation not present at baseline or death between 72 and 120 hours after treatment initiation. SECONDARY Time to clinical stability Length of ICU and hospital stay In‐hospital mortality Inflammatory markers Safety
Notes	Study location: Spain
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer‐generated randomization scheme
Allocation concealment (selection bias)	Low risk	Randomization list kept confidential by the pharmacist
Blinding (performance bias and detection bias) All outcomes	Low risk	Participants: yes Care‐givers: yes Data collectors: yes Outcome assessors: yes Data analysts: yes
Incomplete outcome data (attrition bias) All outcomes	Low risk	Lost to follow‐up: none
Selective reporting (reporting bias)	Low risk	Access to full protocol and unpublished information
Other bias	Low risk	Access to full protocol and unpublished information