Fang F, et al. - In this study, investigators assessed the association of reduced 28-day mortality with corticosteroids administration in individuals with sepsis. They also noted a significant relation of corticosteroid use with enhanced shock reversal and vasopressor-free days. A correlation was also reported between corticosteroids administration and declined intensive care unit length of stay, the Sequential Organ Failure Assessment score at day 7, and time to resolution of shock.

Methods

• They searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception until March 20, 2018, and updated on August 10, 2018.
• They searched the following terms: corticosteroids, sepsis, septic shock, hydrocortisone, controlled trials, and randomized controlled trial, alone or in combination.
• They included randomized clinical trials (RCTs) which compared the administration of corticosteroids with placebo or standard supportive care in adults with sepsis.
• They conducted meta-analyses using a random-effects model to calculate risk ratios (RRs) and mean differences (MDs) with corresponding 95% Cis.
• Citation screening, data abstraction, and risk assessment were completed by 2 independent reviewers.
• Main outcomes and measures included 28–day mortality.

Results

• They involved 37 RCTs (N=9564 candidates) in this meta-analysis.
• They rated 11 trials as low risk of bias.
• They observed an association of corticosteroid use with decline in 28-day mortality (RR, 0.90; 95% CI, 0.82-0.98; I2=27%) and intensive care unit (ICU) mortality (RR, 0.85; 95% CI, 0.77-0.94; I2=0%) and in-hospital mortality (RR, 0.88; 95% CI, 0.79-0.99; I2=38%).
• They also noticed that corticosteroids were significantly associated with increased shock reversal at day 7 (MD, 1.95; 95% CI, 0.80-3.11) and vasopressor-free days (MD, 1.95; 95% CI, 0.80-3.11) and with ICU length of stay (MD, −1.16; 95% CI, −2.12 to −0.20), the sequential organ failure assessment score at day 7 (MD, −1.38; 95% CI, −1.87 to −0.89), and time to resolution of shock (MD, −1.35; 95% CI, −1.78 to −0.91).
• Although, corticosteroid use was linked to increased risk of hyperglycemia (RR, 1.19; 95% CI, 1.08-1.30) and hypernatremia (RR, 1.57; 95% CI, 1.24-1.99) too.