Low-dose hydrocortisone therapy attenuates septic shock in adult patients but does not reduce 28-day mortality: a meta-analysis of randomized controlled trials.
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 I = 26.9%) and 28 days (6 RCTs, N = 947, OR = 1.495, 95% CI, 1.12-1.99, P = 0.006, and I = 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.
Changsong
C
Wang
Jiaxiao
J
Sun
Juanjuan
J
Zheng
Lei
L
Guo
Hongyan
H
Ma
Yang
Y
Zhang
Fengmin
F
Zhang
Enyou
E
Li
D000328:Adult; D006439:Hemodynamics; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D015233:Models, Statistical; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality*; D013997:Time Factors; D016896:Treatment Outcome
D006854:Hydrocortisone