Can corticosteroids reduce the mortality of patients with severe sepsis? A systematic review and meta-analysis.

  title={Can corticosteroids reduce the mortality of patients with severe sepsis? A systematic review and meta-analysis.},
  author={Yuenan Ni and Yuanfei Liu and Yiwei Wang and Bin‐miao Liang and Zong-An Liang},
  journal={The American journal of emergency medicine},
BACKGROUND The effects of corticosteroids on clinical outcomes of patients with sepsis remains controversial. We aimed to further determine the effectiveness of corticosteroids in reducing mortality in adult patients with severe sepsis by comparison with placebo. METHODS Pubmed, Embase, Medline, Cochrane Central Register of Controlled Trials (CENTRAL) as well as the Information Sciences Institute (ISI) Web of Science were searched for all controlled studies that compared corticosteroids and… 
8 Citations
Intravenous corticosteroid treatment in adult patients with sepsis defined by the Sepsis-3 criteria: a systematic review and meta-analysis
It is suggested that intravenous corticosteroid treatment compared to placebo or standard of care may not reduce the 28-day mortality in adult patients with sepsis defined by the Sepsis-3 criteria.
Are Corticosteroids Beneficial for Sepsis and Septic Shock? Based on Pooling Analysis of 16 Studies
The 28-day mortality was reduced, as well as the mortality in the ICU and hospital and the length of stay in theICU, using a long course of low-dose corticosteroids, by a meta-analysis of the current optimal available evidence.
Impact and Beneficial Critical Points of Clinical Outcome in Corticosteroid Management of Adult Patients With Sepsis: Meta-Analysis and GRADE Assessment
This meta-analysis found that the long course low-dose and not short course high-dose corticosteroid treatment could marginally improve short-term 28-day mortality with high quality, especially septic shock and vasopressor-dependent sepsis.
Corticosteroids for treating sepsis in children and adults.
Moderate-certainty evidence shows that there is probably little or no difference in gastroduodenal bleeding, stroke, or cardiac events, and low- Certainty evidence suggests that corticosteroids may result in little to no change in neuropsychiatric events.
Effectiveness of corticosteroids in patients with sepsis or septic shock using the new third international consensus definitions (Sepsis-3): A retrospective observational study
In patients with sepsis or septic shock, intravenous corticosteroids were not associated with a higher in-hospital survival up to 50 days regardless of the Sepsis-3 definitions.
Why My Steroid Trials in Septic Shock Were "Positive"?
Potential explanations for discrepancies in trials’ findings in four domains are explored, that is, study population, experimental interventions, outcomes, and risk of bias.
Effects of low-dose hydrocortisone and hydrocortisone plus fludrocortisone in adults with septic shock: a protocol for a systematic review and meta-analysis of individual participant data
An individual patient data meta-analysis (IPDMA) on the effect of hydrocortisone with or without fludrocort isone compared with placebo or usual care on 90-day mortality and other outcomes in patients with septic shock is performed.
Hydrocortisone with fludrocortisone for septic shock: a systematic review and meta‐analysis
This work aimed to elucidate the beneficial effects of a dual corticosteroid treatment regime involving both hydrocortisone and fludrocort isone for adult patients with septic shock on mortality.


Corticosteroids in the treatment of severe sepsis and septic shock in adults: a systematic review.
The benefits and risks of corticosteroid treatment in severe sepsis and septic shock and the influence of dose and duration are examined and analysis of this subgroup suggests a beneficial drug effect on short-term mortality.
Glucocorticosteroids for sepsis: systematic review with meta-analysis and trial sequential analysis
Evidence to support or negate the use of steroids in any dose in sepsis patients is lacking and it is shown that many more randomised patients are needed before definitive conclusions may be drawn.
Systemic steroids in severe sepsis and septic shock.
  • G. Patel, R. Balk
  • Medicine
    American journal of respiratory and critical care medicine
  • 2012
This concise evidence-based review highlights the strengths and weaknesses of the current data to inform the practicing clinician as to which patients are likely to derive significant benefit from corticosteroid treatment, while waiting for more definitive guidance from future multicenter, prospective, randomized, controlled trials designed to better answer these important therapeutic questions.
Hydrocortisone treatment in early sepsis-associated acute respiratory distress syndrome: results of a randomized controlled trial
In sepsis-associated ARDS, hydrocortisone treatment was associated with a significant improvement in pulmonary physiology, but without a significant survival benefit.
The effects of moderate-dose steroid therapy in sepsis: A placebo-controlled, randomized study
Investigating endocrinologic changes and the effects of moderate dosage steroid treatment in patients with sepsis found higher basal cortisol and peak cortisol levels were found more reliable mortality indicators compared to RAI, and ACTH level was a significant indicator of mortality.
Adjunctive Glucocorticoid Therapy in Patients with Septic Shock
Among patients with septic shock undergoing mechanical ventilation, a continuous infusion of hydrocortisone did not result in lower 90‐day mortality than placebo and there were no significant between‐group differences with respect to mortality at 28 days, the rate of recurrence of shock, the number of days alive and out of the ICU, the Recurrence of mechanical ventilation.
Low-dose hydrocortisone in patients with cirrhosis and septic shock: a randomized controlled trial
Despite initial favourable effects on hemodynamic parameters, hydrocortisone therapy did not reduce mortality and was associated with an increase in adverse effects.
Early dexamethasone treatment for septic shock patients: a prospective randomized clinical trial.
Early treatment with dexamethasone reduced the seven- day mortality among septic shock patients and showed a trend towards reduction of 28-day mortality.
Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations.
RATIONALE Reducing the global burden of sepsis, a recognized global health challenge, requires comprehensive data on the incidence and mortality on a global scale. OBJECTIVES To estimate the
Early initiation of low‐dose hydrocortisone treatment for septic shock in adults: A randomized clinical trial
The early initiation of low‐dose of hydrocortisone did not decrease the risk of mortality, and the length of stay in the ICU or hospital in adults with septic shock, as well as the duration of ICU and hospital stay.