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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*

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

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.

From the *Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University; Department of Medical Records, the First Hospital of Quanzhou, Quanzhou, China; Department of Microbiology, The Heilongjiang Key Laboratory of Immunity and Infection, Pathogenic Biology, Harbin Medical University; and §Key Laboratory of Bio-Pharmaceutical, Harbin Medical University, Ministry of Education, Harbin, China.Jiaxiao Sun, MSc, is currently affiliated with Department of Anesthesiology, the First Hospital of Quanzhou, Quanzhou, China. Juanjuan Zheng, is currently affiliated with Department of Medical Records, the First Hospital of Quanzhou, Quanzhou, China.

Accepted for publication October 18, 2013.

Funding: Financial support by grants from the National Natural Science Foundation of China (No.30972839), China Postdoctoral Science Foundation (No. 2013M531069), Foundation of Heilongjiang Educational Committee (No.12531245) and Doctoral Fund of the First Affiliated Hospital of Harbin Medical University (No.2012B006) are gratefully acknowledged.

Dr. Changsong Wang and Jiaxiao Sun contributed equally to this work.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Enyou Li, MD, Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, No 23 Youzheng St., Nangang District, Harbin, Heilongjiang 150001, China. Address e-mail to enyouli@aliyun.com.

© 2014 International Anesthesia Research Society