Effect of integrative medicines on 28-day mortality from sepsis: a systematic review and network meta-analysis

The aim is to perform a network meta-analysis to evaluate the effect of different Chinese medicines combined with Western medicine treatment (WMT) on the 28-day mortality of patients with sepsis.

We searched multiple databases for randomized controlled trials (RCTs), using keywords such as sepsis, Shenfu, Shenmai, Shengmai, Dahuang Fuzi, Xuebijing, and mortality. The databases we searched included the China Knowledge Network (CNKI), Wanfang database, the Chinese scientific journal database (VIP), the Chinese biomedical literature database (CBM), PubMed, Embase and Cochrane. The collection time was from inception through September 22, 2020. Two researchers independently screened the articles, extracted data, and assessed the quality of the evidence. Stata15 was used for network meta-analysis, and Excel was used to summarize the list of adverse reactions.

Twenty-nine studies with a total of 3201 patients were included in this study. Combined with WMT, Shenfu injection [OR = 0.63, 95% CI = (0.47, 0.83)] and Xuebijing injection [OR = 0.71, 95% CI = (0.52, 0.96)] can significantly reduce 28-day mortality among patients with sepsis, while Shenmai injection [OR = 0.40, 95% CI = (0.16, 1.03)] and Dahuang Fuzi decoction [OR = 1.00, 95% CI = (0.48, 2.10)] cannot significantly improve on the 28-day mortality. The efficacy ranking is as follows: Shenmai group (level of evidence: low) > Shenfu group (level of evidence: low) > Xuebijing group (level of evidence: very low) > WMT group > Dahuangfuzi group (level of evidence: very low).

Combined with WMT, Shenfu injection or Xuebijing injection can reduce the 28-day mortality among patients with sepsis. The Shenfu group had the best effect on outcomes, and its level of evidence was higher than that of the Xuebijing group.