JOURNAL ARTICLE

Steroid controversy in sepsis and septic shock: a meta-analysis

R Lefering, E A Neugebauer
Critical Care Medicine 1995, 23 (7): 1294-303
7600840

OBJECTIVE: The use of corticosteroids in patients with sepsis or septic shock has been controversial for many decades. Clinical studies have reported beneficial, as well as negative results. We conducted a meta-analysis to assess the clinical evidence and to evaluate treatment effects in specific subgroups of patients.

DESIGN: Meta-analysis.

DATA SOURCES: A comprehensive search of the literature revealed 49 publications investigating the effect of corticosteroids in patients with sepsis and septic shock.

STUDY SELECTION: Only ten of the 49 publications were prospective, randomized, controlled trials with an exact description of dosage and regimen.

DATA EXTRACTION: Treatment effects on mortality were calculated as rate differences in each study (negative values favor steroids), and were combined with respect to the variability in each study.

DATA SYNTHESIS: Only one study showed a significantly positive effect of steroid treatment. Overall, no positive effect was observed: -0.2% (95% confidence interval: -9.2, 8.8). There were no differences observed when comparing low- vs. high-dose or type of corticosteroid used. Comparing patients with proven Gram-positive or Gram-negative infection showed a slight but not significant difference. The Gram-negative group demonstrated better outcome (-5.6% vs. 1.8%). A quality rating of each trial showed a remarkable increase in quality over time. Adverse events (gastrointestinal bleeding, secondary infections, hyperglycemia) were not more frequent in patients treated with steroids compared with controls.

CONCLUSIONS: No overall beneficial effect of corticosteroids in patients with septic shock was observed; however, there is some evidence for a positive effect in patients with Gram-negative septicemia.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read
7600840
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"