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. 2024 Jan 19;6(1):e1000.
doi: 10.1097/CCE.0000000000001000. eCollection 2024 Jan.

Corticosteroids in Sepsis and Septic Shock: A Systematic Review, Pairwise, and Dose-Response Meta-Analysis

Tyler Pitre  1 , Katherine Drover  2 , Dipayan Chaudhuri  3   4 , Dena Zeraaktkar  3   5 , Kusum Menon  6 , Hayley B Gershengorn  7   8 , Namita Jayaprakash  9 , Joanna L Spencer-Segal  10 , Stephen M Pastores  11 , Andrea M Nei  12 , Djillali Annane  13 , Bram Rochwerg  3   4
Affiliations

Corticosteroids in Sepsis and Septic Shock: A Systematic Review, Pairwise, and Dose-Response Meta-Analysis

Tyler Pitre et al. Crit Care Explor. .

Abstract

Objectives: To perform a systematic review and meta-analysis to assess the efficacy and safety of corticosteroids in patients with sepsis.

Data sources: We searched PubMed, Embase, and the Cochrane Library, up to January 10, 2023.

Study selection: We included randomized controlled trials (RCTs) comparing corticosteroids with placebo or standard care with sepsis.

Data extraction: The critical outcomes of interest included mortality, shock reversal, length of stay in the ICU, and adverse events.

Data analysis: We performed both a pairwise and dose-response meta-analysis to evaluate the effect of different corticosteroid doses on outcomes. We used Grading of Recommendations Assessment, Development and Evaluation to assess certainty in pooled estimates.

Data synthesis: We included 45 RCTs involving 9563 patients. Corticosteroids probably reduce short-term mortality (risk ratio [RR], 0.93; 95% CI, 0.88-0.99; moderate certainty) and increase shock reversal at 7 days (RR, 1.24; 95% CI, 1.11-1.38; high certainty). Corticosteroids may have no important effect on duration of ICU stay (mean difference, -0.6 fewer days; 95% CI, 1.48 fewer to 0.27 more; low certainty); however, probably increase the risk of hyperglycemia (RR, 1.13; 95% CI, 1.08-1.18; moderate certainty) and hypernatremia (RR, 1.64; 95% CI, 1.32-2.03; moderate certainty) and may increase the risk of neuromuscular weakness (RR, 1.21; 95% CI, 1.01-1.45; low certainty). The dose-response analysis showed a reduction in mortality with corticosteroids with optimal dosing of approximately 260 mg/d of hydrocortisone (RR, 0.90; 95% CI, 0.83-0.98) or equivalent.

Conclusions: We found that corticosteroids may reduce mortality and increase shock reversal but they may also increase the risk of hyperglycemia, hypernatremia, and neuromuscular weakness. The dose-response analysis indicates optimal dosing is around 260 mg/d of hydrocortisone or equivalent.

Keywords: corticosteroids; critical illness; meta-analysis; sepsis; septic shock.

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Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Forest plot for short-term mortality. ML = Maximum likelihood.
Figure 2.
Figure 2.
Dose-response analysis for short-term mortality, with the representing the effect size and the ribbons representing the 95% CIs.
See this image and copyright information in PMC

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