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Can corticosteroids reduce the mortality of patients with severe sepsis? A systematic review and meta-analysis

  • Author Footnotes
    1 These authors contributed equally to this work.
    Yue-Nan Ni
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, 610041, China
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Yuan-Ming Liu
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Respiratory and Critical Care Medicine, People's Hospital of Pengzhou City, 611930, China
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  • Yi-Wei Wang
    Affiliations
    Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, 610041, China
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  • Bin-Miao Liang
    Correspondence
    Corresponding author.
    Affiliations
    Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, 610041, China
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  • Zong-An Liang
    Correspondence
    Corresponding author at: No.37 Guoxue Alley, Chengdu 610041, China.
    Affiliations
    Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, 610041, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.
Published:November 26, 2018DOI:https://doi.org/10.1016/j.ajem.2018.11.040

      Abstract

      Background

      The effects of corticosteroids on clinical outcomes of patients with sepsis remains controversial. We aimed to further determine the effectiveness of corticosteroids in reducing mortality in adult patients with severe sepsis by comparison with placebo.

      Methods

      Pubmed, Embase, Medline, Cochrane Central Register of Controlled Trials (CENTRAL) as well as the Information Sciences Institute (ISI) Web of Science were searched for all controlled studies that compared corticosteroids and placebo in adult patients with severe sepsis. The primary outcome was the mortality 28-day mortality and the secondary outcomes were mortality at longest follow up, occurrence, and reoccurrence of septic shock.

      Results

      A total of 19 trials involving 7035 patients were pooled in our final analyses. No significant heterogeneity was found in any of the outcome measures. Compared with placebo, corticosteroids were associated with a lower 28-day mortality (RR 0.91, 95% CI 0.85–0.98, Z = 2.57, P = 0.01) both in patients having sepsis and in those who developed septic shock (RR 0.92, 95% CI 0.85–0.99, Z = 2.19, P = 0.03), while no significant difference was found in mortality with the longest follow up in patients either having sepsis (RR 0.94, 95% CI 0.89–1.00, Z = 1.93, P = 0.05), or occurrence (RR 0.83, 95% CI 0.56–1.24, Z = 0.90, P = 0.37) or reoccurrence of septic shock (RR 1.08, 95% CI 1.00–1.16, Z = 1.89, P = 0.06).

      Conclusions

      Corticosteroids were effective in reducing the 28-day mortality in patients with severe sepsis and in those with septic shock.

      Keywords

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