Corticosteroids associated with improved mortality rates in sepsis
Corticosteroid treatment in patients with sepsis significantly improved health care outcomes, including a reduction in 28-day mortality, according to findings published in JAMA Internal Medicine.
“Although corticosteroids are widely used for adults with sepsis, both the overall benefit and potential risks remain unclear,” Fang Fang, MD, from West China Hospital and Sichuan University, and colleagues wrote.
Fang and colleagues conducted a systematic review and meta-analysis of 37 randomized controlled trials to determine the safety and efficacy of corticosteroids in patients with sepsis (n = 9,564). The researchers included trials that compared corticosteroid therapy with standard supportive care or placebo. The primary outcome was 28-day mortality. Eleven trials had a low risk for bias.
The researchers found that reduced 28-day mortality (RR = 0.9; 95% CI, 0.82-0.98), ICU mortality (RR = 0.85; 95% CI, 0.77-0.94) and in-hospital mortality (RR = 0.88; 95% CI, 0.79-0.99) were associated with corticosteroid use.
There was a significant association between corticosteroids and increased shock reversal at day 7 (mean difference = 1.95; 95% CI, 0.8-3.11) and vasopressor-free days (mean difference = 1.95; 95% CI, 0.8-3.11). Corticosteroid use was also significantly associated with ICU length of stay (mean difference = –1.16; 95% CI, –2.12 to –0.2), the sequential organ failure assessment score at day 7 (mean difference = –1.38; 95% CI, –1.87 to –0.89) and time to resolution of shock (mean difference = –1.35; 95% CI, –1.78 to –0.91).
However, patients using corticosteroids were more likely to develop hyperglycemia (RR = 1.19; 95% CI, 1.08-1.3) and hypernatremia (RR = 1.57; 95% CI, 1.24-1.99).
“These findings appear to indicate that corticosteroids should be prescribed at a low dose and for a long course,” Fang and colleagues concluded. “However, the optimal strategy for the administration of corticosteroids in patients with sepsis is uncertain. Future studies are needed to associate personalized medicine with clinical phenotyping, genotyping, or metabolomics with the treatment of sepsis for the selection of suitable patients who are more likely to show a benefit.” – by Alaina Tedesco
Disclosures: The authors report no relevant financial disclosures.