Large Intrathoracic Tumor

Devakonda, Arun; Kurugundla, Navatha; Amchentsev, Alexey; Saleh, Anthony G.; Patel, Rubal

doi:10.1378/chest.134.4_meetingabstracts.c44002

Cited by 1 publication

(1 citation statement)

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“…Thus, the studies extracted different data from several included RCTs that reported 28-day and 90-day mortality at once. In addition, 3 of the trials were excluded from this analysis because 28-day mortality was not reported; however, they were included in the aforementioned report. Third, the authors used a fixed-effects model, whereas the random-effects model was used in this study because of the high level of clinic heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

Association of Corticosteroid Treatment With Outcomes in Adult Patients With Sepsis

et al. 2019

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IMPORTANCEAlthough corticosteroids are widely used for adults with sepsis, both the overall benefit and potential risks remain unclear.OBJECTIVE To conduct a systematic review and meta-analysis of the efficacy and safety of corticosteroids in patients with sepsis. DATA SOURCES AND STUDY SELECTION MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception until March 20, 2018, and updated on August 10, 2018. The terms corticosteroids, sepsis, septic shock, hydrocortisone, controlled trials, and randomized controlled trial were searched alone or in combination. Randomized clinical trials (RCTs) were included that compared administration of corticosteroids with placebo or standard supportive care in adults with sepsis.DATA EXTRACTION AND SYNTHESIS Meta-analyses were conducted using a random-effects model to calculate risk ratios (RRs) and mean differences (MDs) with corresponding 95% CIs. Two independent reviewers completed citation screening, data abstraction, and risk assessment. MAIN OUTCOMES AND MEASURES Twenty-eight-day mortality.RESULTS This meta-analysis included 37 RCTs (N = 9564 patients). Eleven trials were rated as low risk of bias. Corticosteroid use was associated with reduced 28-day mortality (RR, 0.90; 95% CI, 0.82-0.98; I 2 = 27%) and intensive care unit (ICU) mortality (RR, 0.85; 95% CI, 0.77-0.94; I 2 = 0%) and in-hospital mortality (RR, 0.88; 95% CI, 0.79-0.99; I 2 = 38%). 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). However, corticosteroid use was associated with increased risk of hyperglycemia (RR, 1.19; 95% CI, 1.08-1.30) and hypernatremia (RR, 1.57; 95% CI, 1.24-1.99). CONCLUSIONS AND RELEVANCEThe findings suggest that administration of corticosteroids is associated with reduced 28-day mortality compared with placebo use or standard supportive care. More research is needed to associate personalized medicine with the corticosteroid treatment to select suitable patients who are more likely to show a benefit.

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Section: Discussionmentioning

confidence: 99%