Corticosteroids in septic shock: a systematic review and network meta-analysis

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Corticosteroids in septic shock: a systematic review and network meta-analysis
Key Take-Away: 

Corticosteroids are high dose immunosuppressive agents that recently established as low dose hydrocortisones in the treatment of septic shocks. This systematic review portrayed strong evidence of differential efficacy in the area of shock reversal which was more likely due to hydrocortisone boluses and infusions.

Multiple corticosteroids and treatment regimens have been used as adjuncts in the treatment of septic shock.

ABSTRACT: 
Background: 

Multiple corticosteroids and treatment regimens have been used as adjuncts in the treatment of septic shock. Qualitative and quantitative differences exist at cellular and tissue levels between the different drugs and their patterns of delivery.

The objective of this study was to elucidate any differences between the drugs and their treatment regimens regarding outcomes for corticosteroid use in adult patients with septic shock.

Methods: 

Network meta-analysis of the data used for the recently conducted Cochrane review was performed.

Studies that included children and were designed to assess respiratory function in pneumonia and acute respiratory distress syndrome, as well as cross-over studies, were excluded. Network plots were created for each outcome, and all analyses were conducted using a frequentist approach assuming a random-effects model.

Results: 

Complete data from 22 studies and partial data from 1 study were included. Network meta-analysis provided no clear evidence that any intervention or treatment regimen is better than any other across the spectrum of outcomes.

There was strong evidence of differential efficacy in only one area: shock reversal. Hydrocortisone boluses and infusions were more likely than methylprednisolone boluses and placebo to result in shock reversal.

Conclusion: 

There was no clear evidence that anyone corticosteroid drug or treatment regimen is more likely to be effective in reducing mortality or reducing the incidence of gastrointestinal bleeding or super infection in septic shock.

There was no clear evidence that anyone corticosteroid drug or treatment regimen is more likely to be effective in reducing mortality or reducing the incidence of gastrointestinal bleeding or super infection in septic shock. Hydrocortisone delivered as a bolus or as an infusion was more likely than placebo and methylprednisolone to result in shock reversal.

Source:

Critical Care

Link to the source:

http://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1659-4

Original title of article:

Corticosteroids in septic shock: a systematic review and network meta-analysis

Authors:

Jessica K. Goeller et al

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