Corticosteroids in septic shock: a systematic review and network meta-analysis

Background Multiple corticosteroids and treatment regimens have been used as adjuncts in the treatment of septic shock. Qualitative and quantitative differences exist at cellular and tissular levels between the different drugs and their patterns of delivery. The objective of this study was to elucid...

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Vydané v:	Critical care (London, England) Ročník 21; číslo 1; s. 78 - 8
Hlavní autori:	Gibbison, Ben, López-López, José A., Higgins, Julian P. T., Miller, Tom, Angelini, Gianni D., Lightman, Stafford L., Annane, Djillali
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	London BioMed Central 28.03.2017 BioMed Central Ltd Springer Nature B.V BMC
Predmet:	Adrenal Adrenal Cortex Hormones - pharmacology Adrenal Cortex Hormones - therapeutic use Adrenal glands Adult Child Clinical trials Corticosteroids Critical care Critical Care Medicine Dosage and administration Drug dosages Drug therapy Emergency Medicine Evidence-based medicine Gastrointestinal Hemorrhage - prevention & control Glucocorticoids Hospital Mortality Humans Hyperglycemia Illnesses Immunomodulators Intensive Medicine Medicine & Public Health Meta-analysis Mortality Patient outcomes Respiratory distress syndrome Sepsis Septic shock Shock, Septic - drug therapy Shock, Septic - mortality Steroids Systematic review Critical care Sepsis Septic shock Glucocorticoids Adrenal Steroids
ISSN:	1364-8535, 1466-609X, 1364-8535, 1466-609X, 1366-609X
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Popis
Shrnutí:	Background Multiple corticosteroids and treatment regimens have been used as adjuncts in the treatment of septic shock. Qualitative and quantitative differences exist at cellular and tissular levels between the different drugs and their patterns of delivery. The objective of this study was to elucidate any differences between the drugs and their treatment regimens regarding outcomes for corticosteroid use in adult patients with septic shock. Methods Network meta-analysis of the data used for the recently conducted Cochrane review was performed. Studies that included children and were designed to assess respiratory function in pneumonia and acute respiratory distress syndrome, as well as cross-over studies, were excluded. Network plots were created for each outcome, and all analyses were conducted using a frequentist approach assuming a random-effects model. Results Complete data from 22 studies and partial data from 1 study were included. Network meta-analysis provided no clear evidence that any intervention or treatment regimen is better than any other across the spectrum of outcomes. There was strong evidence of differential efficacy in only one area: shock reversal. Hydrocortisone boluses and infusions were more likely than methylprednisolone boluses and placebo to result in shock reversal. Conclusions There was no clear evidence that any one corticosteroid drug or treatment regimen is more likely to be effective in reducing mortality or reducing the incidence of gastrointestinal bleeding or superinfection in septic shock. Hydrocortisone delivered as a bolus or as an infusion was more likely than placebo and methylprednisolone to result in shock reversal.
Bibliografia:	ObjectType-Article-2 SourceType-Scholarly Journals-1 content type line 14 ObjectType-Feature-3 ObjectType-Evidence Based Healthcare-1 ObjectType-Article-1 ObjectType-Feature-2 ObjectType-Review-3 content type line 23 ObjectType-Undefined-4
ISSN:	1364-8535 1466-609X 1364-8535 1466-609X 1366-609X
DOI:	10.1186/s13054-017-1659-4