Acute cardiac care & resuscitation
A Bayesian re-analysis of the STRESS trial
Authors' conclusion
Our Bayesian re-analysis of the STRESS trial, using a range of prior beliefs, demonstrated a high probability that perioperative methylprednisolone reduces the risk of death or major complications in infants undergoing cardiopulmonary bypass compared with placebo. This more in-depth analysis expands the initial clinical evaluation of methylprednisolone provided by the STRESS trial.
Study context
- Population
- Infants undergoing heart surgery with cardiopulmonary bypass
- Participants
- 599 vs 601
- Comparison
- Methylprednisolone versus placebo
- Methylprednisolonen = 599
- Placebon = 601reference
- Outcome
- Ranked composite of:
- Death
- Transplant
- Major complication
- Post op length of stay (original STRESS trial primary endpoint)
Methodological detailscovariate-adjusted proportional odds model, Markov Chain Monte Carlo simulations, nearly noninformative prior distribution (primary analysis)
- Covariate-adjusted proportional odds model
- Markov Chain Monte Carlo simulations
- Nearly noninformative prior distribution (primary analysis)
Main finding
As reported in the abstract
Posterior probability of any benefit from methylprednisolone
92%
Probability of harm
8%
Further findings
| Outcome | Absolute risk difference (95% CI) | |
|---|---|---|
| Composite death or major complication | −2% (−3%, +1%) | |
| −4−202Difference (linear scale) |
| Outcome | Adjusted OR | P value |
|---|---|---|
| Original STRESS trial result (worse outcome) | 0.86 | P = 0.14 |
- Composite death or major complication — Composite death or major complication occurred in subjects
- 18.8%
Sensitivity analyses (9 prior settings)
- Sensitivity analyses demonstrating >80% probability of benefit and ≥1% absolute difference in risk of death, transplant or major complications
- 8 of 9
- Each of 9 sensitivity analyses demonstrated greater probability of benefit than harm in the methylprednisolone group
Secondary analysis with empirical priors from four previous steroid trials
- Posterior probability of benefit
- 95%
Original publication
A Bayesian re-analysis of the STRESS trial. Am Heart J. Published 25 September 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →