Corticosteroids for treating sepsis in children and adults

Sepsis occurs when an infection is complicated by organ failure. Sepsis may be complicated by impaired corticosteroid metabolism. Thus, providing corticosteroids may benefit patients. The original review was published in 2004 and was updated in 2010 and 2015 prior to this update. To examine the effe...

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Bibliographic Details
Published in:Cochrane database of systematic reviews 2019-12, Vol.12 (12), p.CD002243
Main Authors: Annane, Djillali, Bellissant, Eric, Bollaert, Pierre Edouard, Briegel, Josef, Keh, Didier, Kupfer, Yizhak, Pirracchio, Romain, Rochwerg, Bram
Format: Article
Language:English
Subjects:
Adrenal Cortex Hormones - adverse effects
Adrenal Cortex Hormones - therapeutic use
Adult
Child
Child health
Hospital Mortality
Humans
Infectious disease
Length of Stay
Life Sciences
Pain & anaesthesia
Randomized Controlled Trials as Topic
Risk Factors
Sepsis - drug therapy
Sepsis - mortality
Septic shock management
Time Factors
Citations: Items that cite this one
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Summary:Sepsis occurs when an infection is complicated by organ failure. Sepsis may be complicated by impaired corticosteroid metabolism. Thus, providing corticosteroids may benefit patients. The original review was published in 2004 and was updated in 2010 and 2015 prior to this update. To examine the effects of corticosteroids on death in children and adults with sepsis. We searched CENTRAL, MEDLINE, Embase, LILACS, ClinicalTrials.gov, ISRCTN, and the WHO Clinical Trials Search Portal, on 25 July 2019. In addition, we conducted reference checking and citation searching, and contacted study authors, to identify additional studies as needed. We included randomized controlled trials (RCTs) of corticosteroids versus placebo or usual care (antimicrobials, fluid replacement, and vasopressor therapy as needed) in children and adults with sepsis. We also included RCTs of continuous infusion versus intermittent bolus of corticosteroids. All review authors screened and selected studies for inclusion. One review author extracted data, which was checked by the others, and by the lead author of the primary study when possible. We obtained unpublished data from the authors of some trials. We assessed the methodological quality of trials and applied GRADE to assess the certainty of evidence. Review authors did not contribute to assessment of eligibility and risk of bias, nor to data extraction, for trials they had participated in. We included 61 trials (12,192 participants), of which six included only children, two included children and adults, and the remaining trials included only adults. Nine studies are ongoing and will be considered in future versions of this review. We judged 19 trials as being at low risk of bias. Corticosteroids versus placebo or usual care Compared to placebo or usual care, corticosteroids probably slightly reduce 28-day mortality (risk ratio (RR) 0.91, 95% confidence interval (CI) 0.84 to 0.99; 11,233 participants; 50 studies; 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; 6236 participants; 7 studies; low-certainty evidence) and probably slightly reduce hospital mortality (RR 0.90, 95% CI 0.82 to 0.99; 8183 participants; 26 trials; moderate-certainty evidence). Corticosteroids reduced length of intensive care unit (ICU) stay for all participants (mean difference (MD) -1.07 days, 95% CI -1.95 to -0.19; 7612 participants; 21 studies; high-certainty evidence) and
ISSN:1469-493X
1469-493X
DOI:10.1002/14651858.CD002243.pub4