| Bias | Author's judgement | Support for judgement |
| Confounding |
Moderate |
Comment: Some baseline imbalances for comorbidities. In the propensity score matched sample, all confounders of interest are balanced (see Tables 3 and 6 in supplementary files). Trialists do not control for the review confounders, ethnicity and socioeconomic status, but due to China's quite homogeneous society in term of access to health care, this was deemed acceptable. The study also splits the sample by severity, therefore controlling for status of invasive ventilation during ICU admission is not necessary. Sensitivity analysis (cox proportional model) adjusted for time-varying confounding. |
| Selection of participants into the study |
Moderate |
Comment: Follow-up begins at admission to hospital. Most participants started receiving the intervention within 24 hours from admission (see Table 1 and Table 2). Sensitivity analysis (cox proportional model) was conducted to examine immortal time risk. |
| Intervention classification |
Low |
Quote: "We collected the patientsÂ’ clinical data, including demographic information, medical history, laboratory indexes, corticosteroid use and prognosis. Corticosteroid use was defined as the use of intravenous systemic corticosteroids, including hydrocortisone, methylprednisolone, and dexamethasone." Comment: Treatment groups were classified using clearly defined criteria. |
| Deviation from intended intervention |
NI |
Comment: The reported information on the administration of co-interventions of interest is inadequate to assess this domain. Risk assessed to be NI for the outcomes: time to death. |
| Missing data |
Low |
Comment: No participants were excluded due to missing outcome data or missing data on other variables needed for the analysis. Risk assessed to be low for the outcomes: time to death. |
| Measurements of outcomes |
Low |
Comment: Observer-reported outcome (death). Risk assessed to be low for the outcomes: time to death. |
| Selection of the reported results |
Moderate |
Comment: The outcomes and analyses are clearly defined in the Methods section. There is no a-priori registered protocol or statistical analysis plan available. Risk assessed to be moderate for the outcomes: time to death. |