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Corticosteroids for treating severe sepsis and septic shock
D Annane1, E Bellissant, P E Bollaert
1Critical Care Department, Hôpital Raymond Poincaré, Assistance Publique - Hôpitaux de Paris, 104. Boulevard Raymond Poincaré, Garches, Ile de France, France.
The Cochrane Database of Systematic Reviews
|February 20, 2004
Summary
Corticosteroids did not significantly alter overall mortality in severe sepsis and septic shock. However, long-term, low-dose corticosteroid therapy was associated with reduced 28-day mortality and intensive care unit mortality.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Infectious Diseases
Background:
- Sepsis can impair natural corticosteroid production, suggesting a potential therapeutic role for exogenous corticosteroids.
- Patients with severe sepsis and septic shock may experience adrenal insufficiency.
Purpose of the Study:
- To evaluate the impact of corticosteroid administration on one-month mortality in patients diagnosed with severe sepsis or septic shock.
Main Methods:
- A systematic review and meta-analysis of randomized and quasi-randomized controlled trials were conducted.
- Searches included major databases (Cochrane, MEDLINE, EMBASE, LILACS) and reference lists up to August 2003.
- Data extraction and quality assessment were performed by two independent reviewers.
Main Results:
- Corticosteroids did not significantly affect 28-day all-cause mortality or hospital mortality in severe sepsis and septic shock.
- A statistically significant reduction in intensive care unit mortality was observed.
- Corticosteroid use increased the rate of shock reversal by day 7 and day 28 without increasing adverse events like bleeding or superinfection.
Conclusions:
- Overall, corticosteroids do not appear to improve survival in severe sepsis and septic shock.
- Long-term, low-dose corticosteroid regimens demonstrated a significant reduction in 28-day all-cause mortality, as well as intensive care unit and hospital mortality.