Corticosteroids for severe sepsis and septic shock: a systematic review and meta-analysis.
OBJECTIVE
To assess the effects of corticosteroids on mortality in patients with severe sepsis and septic shock.


METHODS
Randomised and quasi-randomised trials of corticosteroids versus placebo (or supportive treatment alone) retrieved from the Cochrane infectious diseases group's trials register, the Cochrane central register of controlled trials, Medline, Embase, and LILACS.


METHODS
Two pairs of reviewers agreed on eligibility of trials. One reviewer entered data on to the computer and four reviewers checked them. We obtained some missing data from authors of trials and assessed methodological quality of trials.


RESULTS
16/23 trials (n = 2063) were selected. Corticosteroids did not change 28 day mortality (15 trials, n = 2022; relative risk 0.92, 95% confidence interval 0.75 to 1.14) or hospital mortality (13 trials, n = 1418; 0.89, 0.71 to 1.11). There was significant heterogeneity. Subgroup analysis on long courses (> or = 5 days) with low dose (< or = 300 mg hydrocortisone or equivalent) corticosteroids showed no more heterogeneity. The relative risk for mortality was 0.80 at 28 days (five trials, n = 465; 0.67 to 0.95) and 0.83 at hospital discharge (five trials, n = 465, 0.71 to 0.97). Use of corticosteroids reduced mortality in intensive care units (four trials, n = 425, 0.83, 0.70 to 0.97), increased shock reversal at 7 days (four trials, n = 425; 1.60, 1.27 to 2.03) and 28 days (four trials, n = 425, 1.26, 1.04 to 1.52) without inducing side effects.


CONCLUSIONS
For all trials, regardless of duration of treatment and dose, use of corticosteroids did not significantly affect mortality. With long courses of low doses of corticosteroids, however, mortality at 28 days and hospital morality was reduced.
Critical Care Department, Université de Versailles Saint-Quentin en Yvelines, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond Poincaré, Garches 92380, France. djillali.annane@rpc.ap-hop-paris.fr
Djillali
D
Annane
Eric
E
Bellissant
Pierre Edouard
PE
Bollaert
Josef
J
Briegel
Didier
D
Keh
Yizhak
Y
Kupfer
D000305:Adrenal Cortex Hormones; D017052:Hospital Mortality; D006801:Humans; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D018805:Sepsis / Q000188:drug therapy* / Q000401:mortality; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality
D000305:Adrenal Cortex Hormones