For sepsis, mortality benefits of corticosteroids persist: Cochrane review

Takeaway

• This Cochrane review confirmed that for patients with sepsis, treatment with corticosteroids decreases mortality and lengths of stay (LOS).
• It found evidence that mortality benefit may extend to the longer term.
• 9 additional trials are underway and may be included in the next revision.

Why this matters

• This review updates the last revision, published in 2015.

Key results

• Corticosteroids vs placebo/usual care:
  • 28-day mortality: risk ratio (RR), 0.91 (95% CI, 0.84-0.99) (50 trials; n=11,233; moderate certainty).
  • Hospital mortality: RR, 0.90 (95% CI, 0.82-0.99) (26 trials; n=8183; moderate certainty).
  • Long-term mortality: RR, 0.97 (95% CI, 0.91-1.03) (7 trials; n=6236; low certainty).
  • ICU LOS: mean, 1.07 fewer days (95% CI, 1.95-0.19 fewer) (21 trials; n=7612; high certainty).
  • Hospital LOS: mean, 1.63 fewer days (95% CI, 2.93-0.33 fewer) (22 trials; n=8795; high certainty).
  • Shock reversal and duration favoured corticosteroid treatment.
• Subgroup analysis revealed comparable results in adult vs paediatric populations.
• Favourability of continuous vs bolus dosing remains unclear.

Study design

• Systematic review and meta-analysis of 61 randomised controlled trials (n=12,192) assessing:
  • Corticosteroids vs placebo or usual care in adults and children with sepsis.
  • Continuous vs bolus dosing.
• Outcomes: mortality; LOS.
• Funding: French hospital, academic sources.

Limitations

• Heterogeneity.