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Glucocorticosteroids for sepsis: systematic review with meta-analysis and trial sequential analysis
M Volbeda1, J Wetterslev, C Gluud
1Department of Critical Care, University of Groningen, University Medical Centre Groningen (UMCG), P.O. Box 30.001, 9700 RB, Groningen, The Netherlands, m.volbeda@umcg.nl.
Intensive Care Medicine
|June 24, 2015
Summary
Current evidence does not support or negate the use of glucocorticosteroids (steroids) for sepsis patients. More large, well-designed clinical trials are needed to determine the benefits and harms of steroid treatment in sepsis.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Clinical Trials
Background:
- Glucocorticosteroids (steroids) are frequently administered to patients with sepsis.
- The efficacy and safety of varying steroid dosages in sepsis management remain uncertain.
- A systematic review and meta-analysis are crucial for clarifying steroid use in sepsis.
Purpose of the Study:
- To systematically review randomized clinical trials evaluating the effects of glucocorticosteroids in sepsis patients.
- To perform meta-analyses and trial sequential analyses (TSA) to assess mortality and serious adverse events.
- To determine the benefits and harms of high-dose versus low-dose steroid administration in sepsis.
Main Methods:
- A systematic review and meta-analysis of randomized clinical trials were conducted following Cochrane methodology.
- Trials involving adult sepsis patients (systemic inflammatory response syndrome to septic shock) were included.
- Primary outcomes included mortality and serious adverse events; TSA and GRADE were used for analysis.
Main Results:
- Thirty-five trials with 4682 patients were analyzed; most trials had a high risk of bias.
- No statistically significant effect of steroids (any dose) on mortality or serious adverse events was found compared to placebo.
- Trial sequential analysis indicated insufficient data for definitive conclusions, requiring more randomized patients.
Conclusions:
- Current evidence is insufficient to support or refute the use of glucocorticosteroids in sepsis patients.
- The benefits and harms of steroid therapy in sepsis remain unclear across all dosages.
- Well-designed, large-scale randomized clinical trials are essential to guide clinical practice.
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