Corticosteroids decrease 28-day mortality in adults with severe sepsis

Reference

Ni YN, Liu YM, Wang YW, Liang BM, Liang ZA. Can corticosteroids reduce the mortality of patients with severe sepsis? A systematic review and meta-analysis. Am J Emerg Med 2018;37(9):1657-1664.

Synopsis

These authors systematically searched multiple databases to identify controlled studies that compared corticosteroids with placebo in adults with severe sepsis. They also manually searched the reference lists of included studies. Two of the authors independently assessed studies for inclusion and for methodologic quality, and they settled discrepancies with a third member of the team. They included 19 studies with 7035 patients; 18 studies reported 28-day survival. Only 2 studies did not have high methodologic quality and the authors did not observe evidence of publication bias. After 28 days, 27% of the steroid-treated patients died compared with 30% of the control patients (number needed to treat = 37, 95% CI 21 - 176). Only 2 studies assessed the occurrence of septic shock and the data demonstrated no effect. The authors point out that the studies all used low doses of corticosteroids (< 300 mg hydrocortisone daily), but the actual doses varied. Their concern, however, is mitigated by the lack of heterogeneity among the results. The authors don't report on the harms of treatment.