Continuous vs. intermittent infusion of corticosteroids in septic shock: a GRADE-based systematic review and...

Septic shock is a fatal infection-induced syndrome causing severe organ dysfunction and high mortality. The study aimed to comprehensively evaluate the effects of continuous versus intermittent bolus hydrocortisone treatment in patients with septic shock, addressing all relevant primary and secondary outcomes.

PubMed, Embase, Scopus, and Web of Science were systematically searched from inception to June 1, 2025, with additional manual sources. Eligible studies included randomized controlled trials and cohort studies of adults with septic shock comparing continuous infusion versus intermittent bolus hydrocortisone. This review followed PRISMA guidelines. Risk of bias was assessed using the Cochrane RoB 2 tool for RCTs and ROBINS-I for cohort studies. Certainty of evidence was graded via the GRADE framework. Primary outcomes were ICU, hospital, and 28-day mortality. Secondary outcomes included 7-day shock reversal, ICU-acquired weakness, ICU and hospital length of stay, vasopressor-free days, duration of vasopressor therapy, and metabolic complications.

This study included 14 studies comparing continuous infusion and intermittent bolus administration of hydrocortisone in patients with septic shock. The findings indicated no significant differences in ICU mortality, hospital mortality, or 28-day mortality between the two groups. However, continuous infusion was associated with significantly improved 7-day shock reversal, reduced risk of hypokalemia, and lower glycemic variability. No significant differences were found between the groups in terms of ICU and hospital length of stay, insulin requirements, and other variables.

These findings suggest that continuous infusion may provide clinical benefits in specific aspects of the management of septic shock patients.

PROSPERO CRD420251069956.