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01-07-2018 | Seven-Day Profile Publication

Low-dose corticosteroids for adult patients with septic shock: a systematic review with meta-analysis and trial sequential analysis

Authors: Sofie Louise Rygård, Ethan Butler, Anders Granholm, Morten Hylander Møller, Jeremy Cohen, Simon Finfer, Anders Perner, John Myburgh, Balasubramanian Venkatesh, Anthony Delaney

Published in: Intensive Care Medicine | Issue 7/2018

Abstract

Purpose

To assess the effect of low dose corticosteroids on outcomes in adults with septic shock.

Methods

We systematically reviewed randomised clinical trials (RCTs) comparing low-dose corticosteroids to placebo in adults with septic shock. Trial selection, data abstraction and risk of bias assessment were performed in duplicate. The primary outcome was short-term mortality. Secondary and tertiary outcomes included longer-term mortality, adverse events, quality of life, and duration of shock, mechanical ventilation and ICU stay.

Results

There were 22 RCTs, including 7297 participants, providing data on short-term mortality. In two low risk of bias trials, the relative risk (RR) of short-term mortality with corticosteroid versus placebo was 0.98 [95% confidence interval (CI) 0.89–1.08, p = 0.71]. Sensitivity analysis including all trials was similar (RR 0.96; 95% CI 0.91–1.02, p = 0.21) as was analysis of longer-term mortality (RR 0.96; 95% CI 0.90–1.02, p = 0.18). In low risk of bias trials, the risk of experiencing any adverse event was higher with corticosteroids; however, there was substantial heterogeneity (RR 1.66; 95% CI 1.03–2.70, p = 0.04, I² = 78%). No trials reported quality of life outcomes. Duration of shock [mean difference (MD) −1.52 days; 95% CI −1.71 to −1.32, p < 0.0001], duration of mechanical ventilation (MD −1.38 days; 95% CI −1.96 to −0.80, p < 0.0001), and ICU stay (MD −0.75 days; 95% CI −1.34 to −0.17, p = 0.01) were shorter with corticosteroids versus placebo.

Conclusions

In adults with septic shock treated with low dose corticosteroids, short- and longer-term mortality are unaffected, adverse events increase, but duration of shock, mechanical ventilation and ICU stay are reduced.

PROSPERO registration no. CRD42017084037.

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Title: Low-dose corticosteroids for adult patients with septic shock: a systematic review with meta-analysis and trial sequential analysis
Authors: Sofie Louise Rygård
Ethan Butler
Anders Granholm
Morten Hylander Møller
Jeremy Cohen
Simon Finfer
Anders Perner
John Myburgh
Balasubramanian Venkatesh
Anthony Delaney
Publication date: 01-07-2018
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 7/2018
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5197-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Low-dose corticosteroids for adult patients with septic shock: a systematic review with meta-analysis and trial sequential analysis

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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