A recent meta-analysis published in the American Journal of Emergency Medicine suggests that corticosteroids significantly reduce the 28-day mortality in patients with severe sepsis and septic shock. Corticosteroids did not show any benefit in long-term mortality, and occurrence and reoccurrence of septic shock.
Researchers conducted a meta-analysis of 19 trials (n=7035 patients with severe sepsis) identified through a literature search on Pubmed, Embase, Medline, Cochrane library databases. The primary outcome was 28-day mortality.
The findings showed that corticosteroids were associated with lower 28-day mortality (RR 0.91, P=.01) compared with placebo. In patients with septic shock, corticosteroids were associated with a significantly lower 28-day mortality (RR 0.92, P=.03). No difference was observed between patients who received corticosteroids vs those who received placebo with respect to mortality at longest follow up (RR, 0.94; P=.05), occurrence of septic shock (RR, 0.83; P=.37) or reoccurrence of septic shock (RR, 1.08; P=.06).
The possible mechanisms underlying the beneficial effects of corticosteroids in sepsis patients include restoration of blood volume, increased cardiac output, recovery of peripheral vascular circulation, increased renal blood flow and improved renal oxygen delivery, and reduction in organ inflammation. The authors call for further studies to profile the characteristics of patients with sepsis who respond well to corticosteroids.