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Corticosteroids for treating severe sepsis and septic shockAnnane D, Bellissant E, Bollaert PE, Briegel J, Keh D, Kupfer Y
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SummaryThere is sufficient evidence to support the use of a long course of low dose of corticosteroids in patients with septic shock.Septic shock is the most severe form of infection. It may also interfere with the production of corticosteroids, a a key hormone for host defence against infection). This review showed that overall corticosteroids did not impact on mortality. However, the trials conducted after 1992 showed that long course (≥ 5 days) of low dose of corticosteroids improved survival in septic shock without causing harm. Trials performed before 1992 showed no benefit from short course of high dose corticosteroids.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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January 26. 2004 AbstractBackgroundSepsis may be complicated by impaired corticosteroid production. Giving corticosteroids could potentially benefit patients. ObjectivesTo examine the effects of corticosteroids on death at one month in patients with severe sepsis and septic shock. Search strategyWe searched the Cochrane Infectious Diseases Group's trial register (August 2003), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2003), MEDLINE (August 2003), EMBASE (August 2003), LILACS (August 2003), reference lists of articles, and also contacted trial authors. Selection criteriaRandomized and quasi-randomized controlled trials of corticosteroids versus placebo or supportive treatment in severe sepsis and septic shock. Data collection and analysisTwo pairs of reviewers agreed the eligibility of trials. One reviewer extracted data, which was checked by the other reviewers and the primary author of the paper whenever possible. We obtained some missing data from the trial authors. We assessed trial methodological quality. Main resultsWe identified 15 trials (n =2023). Corticosteroids did not change 28-day all-cause mortality (15 trials, n = 2022, relative risk (RR) 0.92, 95% confidence interval (CI) 0.75 to 1.14; random effects model) and hospital mortality (13 trials, n = 1418, RR 0.89, 95% CI 0.71 to 1.11; random effects model); however, there was statistically significant heterogeneity, with some evidence that this was related to the dosing strategy. Corticosteroids reduced intensive care unit mortality (4 trials, n = 425, RR 0.83, 95% CI 0.70 to 0.97), increased the proportion of shock reversal by day 7 (6 trials, n = 728, RR 1.22, 95% CI 1.06 to 1.40) and by day 28 (4 trials, n = 425, RR 1.26, 95% CI 1.04 to 1.52), without increasing the rate of gastroduodenal bleeding (10 trials, n = 1321, RR 1.16, 95% CI 0.82 to 1.65), superinfection (12 trials, n = 1705, RR 0.93, 95% CI 0.73 to 1.18), and of hyperglycaemia (6 trials, n = 608, RR 1.22, 0.84 to 1.78). Authors' conclusionsOverall, corticosteroids did not change 28-day mortality and hospital mortality in severe sepsis and septic shock. Long course of low dose corticosteroids reduced 28-day all-cause mortality, and intensive care unit and hospital mortality. |