Cochrane · systematic review · CD002243
Corticosteroids for treating sepsis in children and adults
Annane, D, Bellissant, E, Bollaert, PE, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
7
current version
GRADE rated
7
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 0 · 0%Low 1 · 14.3%Moderate 3 · 42.9%High 3 · 42.9%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyCorticosteroids compared to placebo or usual care for treating sepsis
Population: children and adults with sepsis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
28‐Day all‐cause mortalitya Corticosteroids vs placebo or usual care | RR 0.91 [0.84, 0.99] | 50 studies · 11233 participants | Moderate Downgraded: imprecision, inconsistency |
Long‐term mortalityc Corticosteroids vs placebo or usual care | RR 0.97 [0.91, 1.03] | 7 studies · 6236 participants | Low Downgraded: imprecision, inconsistency |
Hospital mortality Corticosteroids vs placebo or usual care | RR 0.9 [0.82, 0.99] | 26 studies · 8183 participants | Moderate Downgraded: imprecision, inconsistency |
Length of intensive care unit stay for all participants in days Corticosteroids vs placebo or usual care | no estimate extracted | 21 studies · 7612 participants | High |
Length of hospital stay for all participants in days Corticosteroids vs placebo or usual care | no estimate extracted | 22 studies · 8795 participants | High |
Number of participants with adverse events ‐ superinfection (up to longest Corticosteroids vs placebo or usual care | RR 1.06 [0.95, 1.19] | 25 studies · 5356 participants | Moderate Downgraded: imprecision, inconsistency |
Number of participants with adverse events ‐ muscle weakness (up to longest Corticosteroids vs placebo or usual care | RR 1.21 [1.01, 1.44] | 6 studies · 6145 participants | High |
Steroids versus control for treating sepsis
Population: patients with sepsis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
28‐Day all‐cause mortality Steroids vs control | RR 0.87 [0.76, 1] | 27 studies · 3176 participants | Low Downgraded: inconsistency, publication bias |
28‐Day all‐cause mortality by subgroups based on treatment dose/duration ‐ long course of low‐dose corticosteroids Steroids vs control | RR 0.87 [0.78, 0.97] | 22 studies · 2266 participants | Moderate Downgraded: inconsistency |
Hospital mortality Steroids vs control | RR 0.85 [0.73, 0.98] | 17 studies · 2014 participants | Moderate Downgraded: imprecision, inconsistency |
Number of participants with shock reversal at day 7 Steroids vs control | RR 1.31 [1.14, 1.51] | 12 studies · 1561 participants | High |
SOFA score at day 7 Steroids vs control | no estimate extracted | 8 studies · 1132 participants | High |
Length of ICU stay for survivors Steroids vs control | no estimate extracted | 10 studies · 778 participants | High |
Length of hospital stay for survivors Steroids vs control | no estimate extracted | 9 studies · 710 participants | Moderate Downgraded: imprecision |
Number of participants with adverse events ‐ superinfections Steroids vs control | RR 1.02 [0.87, 1.2] | 19 studies · 2567 participants | High |
Number of participants with adverse events ‐ hyperglycaemia Steroids vs control | RR 1.26 [1.16, 1.37] | 13 studies · 2081 participants | High |
Long course low dose corticosteroids compared to placebo or standard therapy for severe sepsis and septic shock
Population: patients with severe sepsis and septic shock
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Long course low dose corticosteroids vs placebo or standard therapy | RR 0.84 [0.72, 0.97] | 12 studies · 1228 participants | Moderate Downgraded: inconsistency, publication bias |
Intensive care unit mortality Long course low dose corticosteroids vs placebo or standard therapy | RR 0.81 [0.63, 1.04] | 8 studies · 1082 participants | Moderate Downgraded: inconsistency, publication bias |
Number of patients with shock reversal Long course low dose corticosteroids vs placebo or standard therapy | RR 1.35 [1.16, 1.57] | 6 studies · 965 participants | Moderate Downgraded: inconsistency, publication bias |
SOFA score Scale from: 0 to 24 (most abnormal). Long course low dose corticosteroids vs placebo or standard therapy | no estimate extracted | 5 studies · 916 participants | Moderate Downgraded: inconsistency, publication bias |
Length of ICU stay Long course low dose corticosteroids vs placebo or standard therapy | no estimate extracted | 8 studies · 622 participants | Moderate Downgraded: inconsistency, publication bias |
Number of patients with adverse events superinfections Long course low dose corticosteroids vs placebo or standard therapy | RR 0.99 [0.8, 1.23] | 14 studies · 1917 participants | Moderate Downgraded: inconsistency, publication bias |