Low-dose corticosteroids in cirrhotic patients with septic shock or vasopressor-dependent shock: A systematic review...

To analyze whether the use of low-dose corticosteroids in cirrhotic patients with septic shock or other forms of vasopressor-dependent distributive shock translates into significant clinical benefits and reduced in-hospital mortality.

PubMed, Embase, and Cochrane CENTRAL were searched for randomized controlled trials (RCTs) and observational studies comparing the use of corticosteroids versus control in cirrhotic patients with septic shock or other distributive vasopressor-dependent shock. Outcomes were analyzed using risk ratios (RR) with 95 % confidence intervals (CIs) and mean differences (MD). Heterogeneity was assessed using the I² statistic.

Six studies (2 RCTs, 4 observational cohorts), totaling 514 patients, were included. Corticosteroids had no effect on in-hospital mortality (RR: 0.99; 95 % CI: 0.86-1.13; p = 0.832; I² = 46.2 %), but reduced refractory shock related mortality (RR: 0.16; 95 % CI: 0.06-0.41; p < 0.001; I² = 0 %) and increased shock resolution (RR: 1.42; 95 % CI: 1.13-1.78; p = 0.003; I² = 52.3 %). No benefit was observed in vasopressor-free days (MD: 2.06; 95 % CI: -0.86 to 4.99; p = 0.166; I² = 58.6 %). Adverse events were higher for gastrointestinal bleeding (RR: 2.73; 95 % CI: 1.15-6.52; p = 0.023; I² = 0 %) and new organ failure (RR: 1.42; 95 % CI: 1.01-1.99; p = 0.045; I² = 0 %).

Low-dose corticosteroids in cirrhotic patients with septic or vasopressor-dependent distributive shock show limited benefit, as improved shock resolution and reduced shock-related mortality did not translate into in-hospital survival and may increase the risk of severe adverse events.