2019 Cochrane Review Update: Does Corticosteroid Treatment Decrease Death Due to Sepsis?
BACKGROUND AND PURPOSE:
Corticosteroids has been used for decades to treat sepsis
In this update to a 2004 Cochrane review, Annane et al. (Cochrane Systematic Reviews, 2019) assessed the effects of corticosteroids on death in children and adults with sepsis
Systematic review and meta-analysis
CENTRAL, MEDLINE, Embase, LILACS,
ClinicalTrials.gov, ISRCTN, and the WHO Clinical Trials Search Portal
Unpublished data from the authors of some trials
RCTs that included: Corticosteroids versus placebo or usual care
(antimicrobials, fluid replacement, and vasopressor therapy as needed) in
children and adults with sepsis | Continuous infusion versus intermittent bolus
Study design and data analysis
All review authors screened and selected studies
One author extracted data, which was checked by
the others, and by the lead author of the primary study when possible
The methodological quality of trials was
assessed using Grade criteria
Total of 61 trials | 12,192 participants
Participants (children vs adults): 6 only
children | 2 with both children and adults | Remainder adults only
9 studies ongoing (to be reviewed in the future)
19 trials were judged as being at low risk of bias
Corticosteroids Versus Placebo or Usual Care
Corticosteroids probably results in reduced 28-day mortality
Risk ratio (RR) 0.91 (95% CI, 0.84 to 0.99; moderate-certainty evidence)
Corticosteroids may result in little to no difference in long-term mortality
RR 0.97 (95% CI, 0.91 to 1.03; low-certainty evidence)
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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