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Anesthesia & Analgesia:
doi: 10.1213/ANE.0000000000000050
Critical Care, Trauma, and Resuscitation: Research Report

Low-Dose Hydrocortisone Therapy Attenuates Septic Shock in Adult Patients but Does Not Reduce 28-Day Mortality: A Meta-Analysis of Randomized Controlled Trials

Wang, Changsong MD*; Sun, Jiaxiao MSc*; Zheng, Juanjuan MSc; Guo, Lei MD*; Ma, Hongyan MD*; Zhang, Yang*; Zhang, Fengmin PhD‡§; Li, Enyou MD*

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Abstract

BACKGROUND: The role of low-dose hydrocortisone in attenuating septic shock and reducing short-term mortality in adult patients with septic shock is unclear. We conducted a meta-analysis of previous studies to determine whether hydrocortisone could ameliorate the effects of septic shock at 7 and 28 days and reduce 28-day morality.

METHODS: Randomized controlled trials (RCTs) of corticosteroids versus placebo (or supportive treatment alone) were retrieved from electronic searches (Medline, Embase, and Cochrane Library databases; LILACS; and Web of Knowledge) and manual searches (up to May 2012). From a pool of 1949 potentially relevant articles, duplicate independent review identified 10 relevant, RCTs of low-dose hydrocortisone therapy in septic shock. Four pairs of reviewers agreed on the criteria for trial eligibility. One reviewer entered the data into the computer, and 3 reviewers checked the data. Missing data were obtained from the authors of the relevant trials. The primary outcome analyzed was an estimate of 28-day mortality.

RESULTS: Eight publications were included in the meta-analysis. Low-dose hydrocortisone therapy did not reduce 28-day mortality (N = 1063; odds ratio (OR) = 0.891, 95% confidence interval (CI), 0.69–1.15). Low-dose hydrocortisone therapy ameliorated shock at 7 days (6 RCTs, N = 964, OR = 2.078, 95% CI, 1.58–2.73, P < 0.0001, and I2 = 26.9%) and 28 days (6 RCTs, N = 947, OR = 1.495, 95% CI, 1.12–1.99, P = 0.006, and I2 = 0.0%).

CONCLUSIONS: Although low-dose hydrocortisone therapy ameliorates septic shock at 7 and 28 days, it does not reduce 28-day mortality.

© 2014 International Anesthesia Research Society

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