Corticosteroids in Sepsis: An Updated Systematic Review and Meta-Analysis

作者：Bram Rochwerg, Simon Oczkowski, Reed Siemieniuk, Thomas Agoritsas, Emilie P. Belley‐Côté, Frédérick D’Aragon, Erick Duan, Shane English, Kira Gossack‐Keenan, Mashari Alghuroba, Wojciech Szczeklik, Kusum Menon, Waleed Alhazzani, Jonathan Sevransky, Per Olav Vandvik, Djillali Annane, Gordon Guyatt · 发表于：Critical Care Medicine · 年份：2018 · DOI：10.1097/ccm.0000000000003262 · 被引用次数：263 · 研究领域：Adrenal Hormones and Disorders、Sepsis Diagnosis and Treatment、Intensive Care Unit Cognitive Disorders

OBJECTIVE: This systematic review and meta-analysis addresses the efficacy and safety of corticosteroids in critically ill patients with sepsis. DATA SOURCES: We updated a comprehensive search of MEDLINE, EMBASE, CENTRAL, and LILACS, and unpublished sources for randomized controlled trials that compared any corticosteroid to placebo or no corticosteroid in critically ill children and adults with sepsis. STUDY SELECTION: Reviewers conducted duplicate screening of citations, data abstraction, and, using a modified Cochrane risk of bias tool, individual study risk of bias assessment. DATA EXTRACTION: A parallel guideline committee provided input on the design and interpretation of the systematic review, including the selection of outcomes important to patients. We assessed overall certainty in evidence using Grading of Recommendations Assessment, Development and Evaluation methodology and performed all analyses using random-effect models. For subgroup analyses, we performed metaregression and considered p value less than 0.05 as significant. DATA SYNTHESIS: Forty-two randomized controlled trials including 10,194 patients proved eligible. Based on low certainty, corticosteroids may achieve a small reduction or no reduction in the relative risk of dying in the short-term (28-31 d) (relative risk, 0.93; 95% CI, 0.84-1.03; 1.8% absolute risk reduction; 95% CI, 4.1% reduction to 0.8% increase), and possibly achieve a small effect on long-term mortality (60 d to 1 yr) based on moderat...