The Effectiveness and Safety of Corticosteroids Therapy in Adult Critical Ill Patients With Septic Shock: A Meta-Analysis of Randomized Controlled Trials

Wen, Yongyao; Zhu, Yunxia; Qimin, Jiang; Guo, Nan; Cai, Yangping; Shen, Xiu-Da

doi:10.1097/shk.0000000000001202

Cited by 8 publications

(9 citation statements)

References 33 publications

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“…Based on extensive search in PubMed and Embase, we found 8 systematic reviews and meta-analyses 18-20 50-54 on the use of corticosteroids in patients with sepsis had been published since 2018. Although all of these reviews included the two largest RCTs, the ADRENAL trial 3 and the APROCCHSS trial, 2 and included a substantial number of other RCTs, they reported contradictory results.…”

Section: Discussionmentioning

confidence: 99%

“…Although all of these reviews included the two largest RCTs, the ADRENAL trial 3 and the APROCCHSS trial, 2 and included a substantial number of other RCTs, they reported contradictory results. In particular, 4 reviews 18 19 50 51 reported that corticosteroids significantly reduced the risk of 28-day mortality, but other four studies 20 52-54 found that intravenous corticosteroids did not lower the risk of either short-term or 28-day mortality. In addition to possible factors such as various outcome definitions or different modeling approaches, we argued that the mixed findings can only be clarified if we first properly standardized the inconsistent definitions for sepsis across previous trials.…”

Section: Discussionmentioning

confidence: 99%

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Intravenous corticosteroid treatment in adult patients with sepsis defined by the Sepsis-3 criteria: a systematic review and meta-analysis

Lin

Hamaya

et al. 2021

Preprint

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Objectives: To summarize the effects of intravenous corticosteroid treatment for sepsis defined by the Sepsis-3 criteria in adult patients. Design: Systematic review and meta-analysis. Methods: We searched RCTs from PubMed, Embase, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, Web of Science, and International Clinical Trials Registry Platform from inception to July 12th, 2019 and updated on June 28th, 2020. Conference proceedings from relevant societies and the reference lists of previous reviews were manually screened. Abstract or full-text articles were screened by two independent investigators. We included RCTs where (1) the participants had infections and the baseline Sequential Organ Failure Assessment (SOFA) score ≥ 2 (the Sepsis-3 definitions) (2) the intervention involved any intravenous corticosteroids; (3) the control group received placebo or standard of care (4) the outcomes of interest included mortality or clinical recovery. We chose the 28-day mortality as the pre-specified primary outcome and risk ratio (RR) as the effect measure. We followed PRISMA guidelines and chose random-effects models for the pooled analyses. Results: This study included 24 RCTs and 19 of them (7,115 participants) reported the 28-day mortality. Pooled analyses showed that intravenous corticosteroid treatment compared to placebo or standard of care was not associated with a lower risk of 28-day mortality (RR, 0.88; 95%CI, 0.73 to 1.05), but with a higher risk of hyperglycemia (RR, 1.16; 95%CI, 1.06 to 1.27). Sensitivity analysis of high-quality studies revealed a similar result for the 28-day mortality (RR, 0.95; 95%CI, 0.86 to 1.05). Conclusions: Our findings suggested that intravenous corticosteroids compared to placebo or standard of care may not reduce the 28-day mortality in adult patients with sepsis defined by the Sepsis-3 criteria. Further studies are warranted to clarify the roles of disease severity and treatment timing in the effects of corticosteroid treatment in this population. PROSPERO registration number: CRD42019143083

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intravenous corticosteroid treatment in adult patients with sepsis defined by the Sepsis-3 criteria: a systematic review and meta-analysis

Lin

Hamaya

et al. 2021

Preprint

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“…Conforme o estudo realizado, os resultados encontrados foram divididos em: artigos que mostraram efeitos e resultados positivos da corticoterapia adjuvante no choque séptico (Annane, 2019;Antcliffe & Gordon, 2019;El-Nawawy, Khater, Omar, & Wali, 2017;Fang et al, 2018;Garza et al, 2018;Gibbison et al, 2017;Law, Sahetya, Walkey, & Delaney, 2018;Lee & Yeh, 2018;Lian et al, 2019;Liu & Menon, 2018;Menon & Mcnally, 2018;Meyer et al, 2019;Pourmand, Whiteside, Yamane, Rashed, & Mazer-Amirshahi, 2019;Russell, 2018. Wen et al, 2019Wong et al, 2016;Zhou, Ye, Li, & Tang, 2018), e resultados negativos do uso complementar dos corticosteroides no choque séptico (Cvijanovich et al, 2017;Lemieux, Levine, & Gritsenko, 2019;Long & Koyfman, 2017;Moskowitz et al, 2020;Salluh & Póvoa, 2017;Yang & Sun, 2020;Zimmerman, 2018).…”

Section: Gráfico 1 Anos De Publicação Dos Artigosunclassified

“…Além disso, levando em consideração os 90 dias, a mortalidade na UTI e a intra-hospitalar, o tempo de permanência hospitalar, a reversão do choque e a superinfecção não tiveram diferença significativa entre a terapia com corticosteroides e a terapia com placebo. Esses resultados foram obtidos ao considerar dosagens tanto baixas quanto altas de corticoides (Wen et al, 2019).…”

Section: Gráfico 1 Anos De Publicação Dos Artigosunclassified

“…É uma emergência hospitalar e o seu manejo adequado compreende o reconhecimento rápido e preciso dos sinais e sintomas clínicos, reversão imediata da hipoperfusão e a administração apropriada de antibióticos (Allen et al, 2019). Com foco principal na hipoperfusão, a corticoterapia adjuvante tem sido usada por mais de 40 anos, embora que atualmente a sua eficácia e segurança ainda permanecem incertas (Wen et al, 2019).…”

Section: Introductionunclassified

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Eficácia Do Uso Dos Corticosteroides Como Terapia Adjuvante No Choque Séptico

Leite

Filho

Sousa

2022

Revista Brasileira de Engenharia de Produção

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Contexto: O choque séptico consiste em um estado de falência circulatória aguda somada a um foco infeccioso ou com predomínio de componente endotóxico. Os corticosteroides são uma classe de fármacos sintetizados com base em hormônios esteroides endócrinos e tem sido usados com foco na hipoperfusão. Entretanto, a eficácia e a segurança da terapia com corticosteroides no choque séptico ainda permanecem incertas, visto que existem tanto relatos de melhora clínica quanto de efeitos adversos graves. Objetivo: Este estudo objetiva avaliar a eficácia da terapia adjuvante com corticosteroides em pacientes com choque séptico a fim de procurar se há evidências científicas que apresentem benefícios desse tratamento, bem como estabelecer, se positivo, o manejo, de acordo com as evidências, nessa patologia. Método: Caracteriza-se como uma Revisão Integrativa, a qual os artigos foram selecionados na plataforma da Biblioteca Virtual em Saúde, em que foram identificados 460 artigos, porém foram selecionados 39 dentre estes. Resultados: Esses estudos foram realizados com mais frequência nos anos de 2017, 2018 e 2019. Após a análise dos dados, sugeriu-se que essa terapêutica se relacionou com uma reversão mais rápida do choque, diminuição dos dias de uso de vasopressores e diminuem o tempo de internação em UTI. Contudo, existem riscos de efeitos adversos. Conclusão: Com isso, concluiu-se que os pacientes candidatos a esse tratamento são aqueles com maior gravidade e/ou que não respondem primeiramente a ressuscitação com fluidos e drogas vasoativas. Ademais o uso dessas medicações deve ser individualizado, levando-se em consideração o fenótipo e o genótipo de cada paciente.

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A Canadian survey of critical care physicians’ hemodynamic management of deceased organ donors

Frenette

Charbonney

D’Aragon

et al. 2019

Can J Anesth/J Can Anesth

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The Effectiveness and Safety of Corticosteroids Therapy in Adult Critical Ill Patients With Septic Shock: A Meta-Analysis of Randomized Controlled Trials

Abstract: Based on the results of this meta-analysis, corticosteroids therapy was associated with a significantly shorter length of stay in ICU among adult cirtical ill patients with septic shock. The mortality was similar between the corticosteroids therapy and placebo.

Cited by 8 publications

References 33 publications

Intravenous corticosteroid treatment in adult patients with sepsis defined by the Sepsis-3 criteria: a systematic review and meta-analysis

Intravenous corticosteroid treatment in adult patients with sepsis defined by the Sepsis-3 criteria: a systematic review and meta-analysis

Eficácia Do Uso Dos Corticosteroides Como Terapia Adjuvante No Choque Séptico

A Canadian survey of critical care physicians’ hemodynamic management of deceased organ donors

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