Efficacy of corticosteroids on survival in patients with sepsis and septic shock: meta-analysis
KeywordsCorticosteroid Septic Shock Severe Sepsis Risk Ratio Randomized Clinical Trial
Previous studies have recommended the use of low-dose corticosteroids in patients with septic shock. Specifically, response to corticotropin tests has been recognized as a prognostic factor in critically ill patients, especially in patients with no response to the corticotropin test. A recent large randomized controlled trial evaluating the efficacy of low-dose corticosteroids revealed no benefit on overall survival or in patients with no response to corticotropin in patients with severe sepsis and septic shock. Recently, recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients were published as consensus statements from an international task force by the American College of Critical Care Medicine . However, some studies were not included in these statements.
We conducted a systematic search of EMBASE and MEDLINE (through August 2008) for double-blind randomized clinical trials that evaluated the effect of corticosteroids on mortality in patients with severe sepsis and septic shock. Study selection criteria were all trials before August 2008 in which participants were randomized to corticosteroids or placebo and in which mortality was reported.
Data from 17 randomized, controlled trials with a total of 3,638 participants were analyzed. Corticosteroid use was not associated with a risk reduction in overall mortality (pooled risk ratio = 0.99 (95% CI = 0.90 to 1.09), P = 0.823). Low-dose corticosteroids (150 to 300 mg/day) did not show benefit on all-cause mortality in patients with severe sepsis and septic shock (risk ratio = 0.92 (95% CI = 0.79 to 1.06)). Furthermore, low-dose corticosteroids in patients with severe sepsis and septic shock who did not respond to the corticotropin test showed no benefit on 28-day mortality (risk ratio = 0.91 (95% CI = 0.76 to 1.09)). Corticosteroids use was not associated with increased complications, such as gastrointestinal bleeding or increased infections.
This meta-analysis indicated that administration of low-dose corticosteroids was not beneficial on overall mortality in patients with severe sepsis or septic shock.
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