Corticosteroids in Sepsis and Septic Shock: A Systematic Review, Pairwise, and Dose-Response Meta-Analysis

The use of corticosteroids in managing sepsis and septic shock remains controversial despite extensive research through randomized controlled trials (RCTs), systematic reviews, and meta-analyses. While some analyses hint at a potential reduction in mortality, this evidence is often characterized by low certainty. Conversely, more robust evidence suggests that corticosteroids can effectively reverse shock and improve organ function compared to standard care or placebo.

However, significant uncertainties persist regarding which specific patient populations might benefit most from corticosteroid therapy. There is also a lack of clarity on how variations in dosage, duration, or the type of corticosteroid used impact treatment outcomes. Recent years have seen an increase in new RCTs investigating these variables, aiming to provide more precise guidance for clinicians.

By incorporating findings from these latest studies, the objective is to refine evidence summaries and offer clearer guidance on the use of corticosteroids in treating sepsis. Corticosteroids probably reduce mortality, increase shock reversal, and decrease SOFA scores in sepsis patients. However, they likely increase the risk of hypernatremia and hyperglycemia and may cause neuromuscular weakness. A dose-response meta-analysis suggests the optimal dosage is 260 mg/day of hydrocortisone or its equivalent.

To read more, click here