title: Corticosteroids in septic shock: a systematic review and network meta-analysis.
abstract: Multiple corticosteroids and treatment regimens have been used as adjuncts in the treatment of septic shock. Qualitative and quantitative differences exist at cellular and tissular levels between the different drugs and their patterns of delivery. The objective of this study was to elucidate any differences between the drugs and their treatment regimens regarding outcomes for corticosteroid use in adult patients with septic shock.
  
  
  
  Network meta-analysis of the data used for the recently conducted Cochrane review was performed. Studies that included children and were designed to assess respiratory function in pneumonia and acute respiratory distress syndrome, as well as cross-over studies, were excluded. Network plots were created for each outcome, and all analyses were conducted using a frequentist approach assuming a random-effects model.
  
  
  
  Complete data from 22 studies and partial data from 1 study were included. Network meta-analysis provided no clear evidence that any intervention or treatment regimen is better than any other across the spectrum of outcomes. There was strong evidence of differential efficacy in only one area: shock reversal. Hydrocortisone boluses and infusions were more likely than methylprednisolone boluses and placebo to result in shock reversal.
  
  
  
  There was no clear evidence that any one corticosteroid drug or treatment regimen is more likely to be effective in reducing mortality or reducing the incidence of gastrointestinal bleeding or superinfection in septic shock. Hydrocortisone delivered as a bolus or as an infusion was more likely than placebo and methylprednisolone to result in shock reversal.
authors.affiliation: Cardiac Anaesthesia and Intensive Care, Bristol Heart Institute - University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK. mdbjjg@bristol.ac.uk.
authors.forename: Ben
authors.identifier: 0000-0003-3635-6212
authors.initials: B
authors.lastname: Gibbison
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: José A
authors.initials: JA
authors.lastname: López-López
authors.affiliation: Centre for Research Synthesis and Decision Analysis, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Julian P T
authors.initials: JP
authors.lastname: Higgins
authors.affiliation: Cardiac Anaesthesia and Intensive Care, Bristol Heart Institute - University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Miller
authors.affiliation: Cardiac Surgery, Bristol Heart Institute - University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.
authors.forename: Gianni D
authors.initials: GD
authors.lastname: Angelini
authors.affiliation: Henry Wellcome Laboratories for Integrative Neuroscience and Metabolism, School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: Stafford L
authors.initials: SL
authors.lastname: Lightman
authors.affiliation: Medicine: Critical Care Medicine, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris (APHP), Garches, France.|School of Medicine, Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France.
authors.forename: Djillali
authors.initials: D
authors.lastname: Annane
mesh_terms: D000305:Adrenal Cortex Hormones / Q000494:pharmacology* / Q000627:therapeutic use; D000328:Adult; D002648:Child; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control; D017052:Hospital Mortality; D006801:Humans; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Adrenal; Critical care; Glucocorticoids; Sepsis; Septic shock; Steroids