Web site designed and maintained by Chris Cairns © SICS EBM Group 2004
Sepsis: Low dose steroids improve outcome and reverse shock
Lead author's name and fax: PC Menneci. Critical care Medicine Department, National Instutute of Health, 10 Center Drive, Building 10, Room 7D43, Bethesda, MD 20892; firstname.lastname@example.org
Three-part Clinical Question:
Dose the administration of corticosteroids to patients with sepsis reverse shock
or improve survival
Search Terms: Steroids, sepsis, septic shock, corticosteroids
Data Sources: Medline
Study Selection: Randomized,
controlled trial design; enrollment of adult patients who ,et criteria for
sepsis or septic shock; and a primary end point, included either the
discontinuation of vasopressor therapy or a change in survival comparing
glucocorticoid treatment with control group with placebo. Similar management of
control and intervention groups with the exception of the trial drug.
Data Extraction: Presence of
sepsis, severe sepsis, or septic shock; type, dose and duration of steroid;
incidence and severity of secondary infection; response to ACTH test; number of
patients with shock reversal; the number of deaths.
Mortality: 13 studies included in the mortality analysis. Overall there was no survival benefit with steroids (Relative Survival Benefit 1.01 (95%CI 0.94-1.09) but there was significant heterogeneity within this group. When the 4 studies published after 1997 were considered separately there was a significant outcome benefit (RSB 1.23 (1.01-1.5). All of these studies used low dose steroids for 5-7 days. There studies demonstrated significant homogeneity.
Shock Reversal: 3 of the 4 trials published after 1997 demonstrated significant shock reversal with steroids.
ACTH Testing: Three of the studies published after 1997 stratified their patients into responders and non-responders to an ACTH stimulation test. The definitions of response differed between the studies. The treatment effect of steroids on mortality or shock reversal did not differ significantly on the basis of this division when these trials were combined (p=0.2 for all).
1) Do the methods allow accurate
testing of the hypothesis? Yes
grade of recommendation can
I make when this study is considered along with other available evidence? A
Appraised by: Dr Chris Cairns. Department of Anaesthesia & Critical Care. Stirling Royal Infirmary, Livilands, Stirling, FK8 2AU; Wednesday, October 20, 2004
Citation: EBM Critical Appraisals. Scottish Intensive Care Society EBM Group. Cairns CJS. 2004. Minneci PC, et al. Meta-analysis: The Effect of Steroids on Survival and Shock during Sepsis Depends on the Dose. Ann Int Med. 2004;141:47-56
Reviewed by MD.
©SICS EBMG 2004