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The Effectiveness and Safety of Corticosteroids Therapy in Adult Critical Ill Patients With Septic Shock

A Meta-Analysis of Randomized Controlled Trials

Wen, Yongyao*; Zhu, Yuhan; Jiang, Qimin; Guo, Nan; Cai, Yangping; Shen, Xiaoxu§

doi: 10.1097/SHK.0000000000001202
Clinical Science Aspects
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Objective: To investigate the effectiveness and safety of corticosteroids therapy in adult critical ill patients with septic shock.

Methods: The PUBMED, EMBASE, Web of Science, Cochrane Library databases were systematically searched from the inception dates to March 24, 2018. To identify randomized controlled trials that evaluating the role of corticosteroids therapy in adult critical ill patients with septic shock. The primary outcome was 28-day mortality. The second outcomes included 90-day mortality, intensive care unit (ICU) mortality, in-hospital mortality, length of stay in ICU, length of stay in hospital, reversal of shock, and superinfection.

Results: A total of 18 randomized controlled trials involving 8,128 adult critical ill patients with septic shock fulfilled the inclusion criteria. The outcomes of this meta-analysis showed that corticosteroids therapy did not significantly reduce the 28-day mortality [RR = 0.94; 95% CI, 0.84–1.05; Z = 1.07 (P = 0.285)]. However, corticosteroids therapy was associated with a significantly shorter length of stay in ICU [WMD = −1.55; 95% CI, −2.19 to −0.91; Z = 4.74 (P = 0.000)]. 90-day mortality, ICU mortality, in-hospital mortality, length of stay in hospital, reversal of shock, and superinfection had no significant difference between the corticosteroids therapy and placebo therapy (P > 0.05). Similar results were obtained in subgroups of trials stratified according to the dose of corticosteroids (high dose or low does).

Conclusions: Based on the results of this meta-analysis, corticosteroids therapy was associated with a significantly shorter length of stay in ICU among adult critical ill patients with septic shock. The mortality was similar between the corticosteroids therapy and placebo.

*The first affiliated hospital of Guangxi University of Chinese Medicine, Nanning, China

Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China

ICU Department of Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China

§CCU Department of Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China

Address reprint requests to Xiaoxu Shen, MD, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing 100029, China. E-mail: ghxiaoxushen@sina.com.

Received 25 April, 2018

Revised 14 May, 2018

Accepted 2 June, 2018

The co-first author is Yongyao Wen.

The authors report no conflicts of interest.

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© 2019 by the Shock Society