- This Cochrane review confirmed that for patients with sepsis, treatment with corticosteroids decreases mortality and lengths of stay (LOS).
- It found evidence that mortality benefit may extend to the longer term.
- 9 additional trials are underway and may be included in the next revision.
Why this matters
- This review updates the last revision, published in 2015.
- Corticosteroids vs placebo/usual care:
- 28-day mortality: risk ratio (RR), 0.91 (95% CI, 0.84-0.99) (50 trials; n=11,233; moderate certainty).
- Hospital mortality: RR, 0.90 (95% CI, 0.82-0.99) (26 trials; n=8183; moderate certainty).
- Long-term mortality: RR, 0.97 (95% CI, 0.91-1.03) (7 trials; n=6236; low certainty).
- ICU LOS: mean, 1.07 fewer days (95% CI, 1.95-0.19 fewer) (21 trials; n=7612; high certainty).
- Hospital LOS: mean, 1.63 fewer days (95% CI, 2.93-0.33 fewer) (22 trials; n=8795; high certainty).
- Shock reversal and duration favored corticosteroid treatment.
- Subgroup analysis revealed comparable results in adult vs pediatric populations.
- Favorability of continuous vs bolus dosing remains unclear.
- Systematic review and meta-analysis of 61 randomized controlled trials (n=12,192) assessing:
- Corticosteroids vs placebo or usual care in adults and children with sepsis.
- Continuous vs bolus dosing.
- Outcomes: mortality; LOS.
- Funding: French hospital, academic sources.