Corticosteroids in Sepsis and Septic Shock: A Systematic Review, Pairwise, and Dose-Response Meta-Analysis
OBJECTIVES:. To perform a systematic review and meta-analysis to assess the efficacy and safety of corticosteroids in patients with sepsis. DATA SOURCES:. We searched PubMed, Embase, and the Cochrane Library, up to January 10, 2023. STUDY SELECTION:. We included randomized controlled trials (RCTs) c...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2024-01-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000001000 |
| _version_ | 1797341098042982400 |
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| author | Tyler Pitre, MD, MA Katherine Drover Dipayan Chaudhuri, MD, MSc Dena Zeraaktkar, PhD Kusum Menon, MD, MSc Hayley B. Gershengorn, MD Namita Jayaprakash, MD Joanna L. Spencer-Segal, MD, PhD Stephen M. Pastores, MD Andrea M. Nei, PharmD Djillali Annane, MD, PhD Bram Rochwerg, MD, MSc |
| author_facet | Tyler Pitre, MD, MA Katherine Drover Dipayan Chaudhuri, MD, MSc Dena Zeraaktkar, PhD Kusum Menon, MD, MSc Hayley B. Gershengorn, MD Namita Jayaprakash, MD Joanna L. Spencer-Segal, MD, PhD Stephen M. Pastores, MD Andrea M. Nei, PharmD Djillali Annane, MD, PhD Bram Rochwerg, MD, MSc |
| author_sort | Tyler Pitre, MD, MA |
| collection | DOAJ |
| description | OBJECTIVES:. To perform a systematic review and meta-analysis to assess the efficacy and safety of corticosteroids in patients with sepsis.
DATA SOURCES:. We searched PubMed, Embase, and the Cochrane Library, up to January 10, 2023.
STUDY SELECTION:. We included randomized controlled trials (RCTs) comparing corticosteroids with placebo or standard care with sepsis.
DATA EXTRACTION:. The critical outcomes of interest included mortality, shock reversal, length of stay in the ICU, and adverse events.
DATA ANALYSIS:. We performed both a pairwise and dose-response meta-analysis to evaluate the effect of different corticosteroid doses on outcomes. We used Grading of Recommendations Assessment, Development and Evaluation to assess certainty in pooled estimates.
DATA SYNTHESIS:. We included 45 RCTs involving 9563 patients. Corticosteroids probably reduce short-term mortality (risk ratio [RR], 0.93; 95% CI, 0.88–0.99; moderate certainty) and increase shock reversal at 7 days (RR, 1.24; 95% CI, 1.11–1.38; high certainty). Corticosteroids may have no important effect on duration of ICU stay (mean difference, –0.6 fewer days; 95% CI, 1.48 fewer to 0.27 more; low certainty); however, probably increase the risk of hyperglycemia (RR, 1.13; 95% CI, 1.08–1.18; moderate certainty) and hypernatremia (RR, 1.64; 95% CI, 1.32–2.03; moderate certainty) and may increase the risk of neuromuscular weakness (RR, 1.21; 95% CI, 1.01–1.45; low certainty). The dose-response analysis showed a reduction in mortality with corticosteroids with optimal dosing of approximately 260 mg/d of hydrocortisone (RR, 0.90; 95% CI, 0.83–0.98) or equivalent.
CONCLUSIONS:. We found that corticosteroids may reduce mortality and increase shock reversal but they may also increase the risk of hyperglycemia, hypernatremia, and neuromuscular weakness. The dose-response analysis indicates optimal dosing is around 260 mg/d of hydrocortisone or equivalent. |
| first_indexed | 2024-03-08T10:12:57Z |
| format | Article |
| id | doaj.art-b7d9fa6aaf2e440b9ae07d756658fd90 |
| institution | Directory Open Access Journal |
| issn | 2639-8028 |
| language | English |
| last_indexed | 2024-03-08T10:12:57Z |
| publishDate | 2024-01-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj.art-b7d9fa6aaf2e440b9ae07d756658fd902024-01-29T07:00:19ZengWolters KluwerCritical Care Explorations2639-80282024-01-0161e100010.1097/CCE.0000000000001000202401000-00012Corticosteroids in Sepsis and Septic Shock: A Systematic Review, Pairwise, and Dose-Response Meta-AnalysisTyler Pitre, MD, MA0Katherine Drover1Dipayan Chaudhuri, MD, MSc2Dena Zeraaktkar, PhD3Kusum Menon, MD, MSc4Hayley B. Gershengorn, MD5Namita Jayaprakash, MD6Joanna L. Spencer-Segal, MD, PhD7Stephen M. Pastores, MD8Andrea M. Nei, PharmD9Djillali Annane, MD, PhD10Bram Rochwerg, MD, MSc111 Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada.2 Department of Health Sciences, McMaster University, Hamilton, ON, Canada.3 Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada.3 Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada.6 Department of Pediatrics, University of Ottawa and Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada.7 Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL.9 Department of Emergency Medicine and Division of Pulmonary and Critical Care Medicine, Henry Ford Health, Detroit, MI.10 Department of Internal Medicine and Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI.11 Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.12 Department of Pharmacy, Mayo Clinic Hospital—Rochester, Rochester, MN.13 General Intensive Care Unit, Raymond Poincare Hospital (APHP), Garches, France and the School of Medicine Simone Veil, University Paris Saclay—Campus UVSQ, Paris, France.3 Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada.OBJECTIVES:. To perform a systematic review and meta-analysis to assess the efficacy and safety of corticosteroids in patients with sepsis. DATA SOURCES:. We searched PubMed, Embase, and the Cochrane Library, up to January 10, 2023. STUDY SELECTION:. We included randomized controlled trials (RCTs) comparing corticosteroids with placebo or standard care with sepsis. DATA EXTRACTION:. The critical outcomes of interest included mortality, shock reversal, length of stay in the ICU, and adverse events. DATA ANALYSIS:. We performed both a pairwise and dose-response meta-analysis to evaluate the effect of different corticosteroid doses on outcomes. We used Grading of Recommendations Assessment, Development and Evaluation to assess certainty in pooled estimates. DATA SYNTHESIS:. We included 45 RCTs involving 9563 patients. Corticosteroids probably reduce short-term mortality (risk ratio [RR], 0.93; 95% CI, 0.88–0.99; moderate certainty) and increase shock reversal at 7 days (RR, 1.24; 95% CI, 1.11–1.38; high certainty). Corticosteroids may have no important effect on duration of ICU stay (mean difference, –0.6 fewer days; 95% CI, 1.48 fewer to 0.27 more; low certainty); however, probably increase the risk of hyperglycemia (RR, 1.13; 95% CI, 1.08–1.18; moderate certainty) and hypernatremia (RR, 1.64; 95% CI, 1.32–2.03; moderate certainty) and may increase the risk of neuromuscular weakness (RR, 1.21; 95% CI, 1.01–1.45; low certainty). The dose-response analysis showed a reduction in mortality with corticosteroids with optimal dosing of approximately 260 mg/d of hydrocortisone (RR, 0.90; 95% CI, 0.83–0.98) or equivalent. CONCLUSIONS:. We found that corticosteroids may reduce mortality and increase shock reversal but they may also increase the risk of hyperglycemia, hypernatremia, and neuromuscular weakness. The dose-response analysis indicates optimal dosing is around 260 mg/d of hydrocortisone or equivalent.http://journals.lww.com/10.1097/CCE.0000000000001000 |
| spellingShingle | Tyler Pitre, MD, MA Katherine Drover Dipayan Chaudhuri, MD, MSc Dena Zeraaktkar, PhD Kusum Menon, MD, MSc Hayley B. Gershengorn, MD Namita Jayaprakash, MD Joanna L. Spencer-Segal, MD, PhD Stephen M. Pastores, MD Andrea M. Nei, PharmD Djillali Annane, MD, PhD Bram Rochwerg, MD, MSc Corticosteroids in Sepsis and Septic Shock: A Systematic Review, Pairwise, and Dose-Response Meta-Analysis Critical Care Explorations |
| title | Corticosteroids in Sepsis and Septic Shock: A Systematic Review, Pairwise, and Dose-Response Meta-Analysis |
| title_full | Corticosteroids in Sepsis and Septic Shock: A Systematic Review, Pairwise, and Dose-Response Meta-Analysis |
| title_fullStr | Corticosteroids in Sepsis and Septic Shock: A Systematic Review, Pairwise, and Dose-Response Meta-Analysis |
| title_full_unstemmed | Corticosteroids in Sepsis and Septic Shock: A Systematic Review, Pairwise, and Dose-Response Meta-Analysis |
| title_short | Corticosteroids in Sepsis and Septic Shock: A Systematic Review, Pairwise, and Dose-Response Meta-Analysis |
| title_sort | corticosteroids in sepsis and septic shock a systematic review pairwise and dose response meta analysis |
| url | http://journals.lww.com/10.1097/CCE.0000000000001000 |
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