For sepsis, mortality benefits of corticosteroids persist: Cochrane

  • Annane D & al.
  • Cochrane Database Syst Rev
  • 6 dic. 2019

  • de Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • 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. 

Key results

  • 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.

Study design

  • 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.

Limitations

  • Heterogeneity.