Corticosteroids in septic shock: a systematic review and network meta-analysis
Abstract 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...
Main Authors: | , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2017-03-01
|
Series: | Critical Care |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s13054-017-1659-4 |
id |
doaj-748bb6fc73ee4ce1a8e48fe2ff435887 |
---|---|
record_format |
Article |
spelling |
doaj-748bb6fc73ee4ce1a8e48fe2ff4358872020-11-24T23:58:53ZengBMCCritical Care1364-85352017-03-012111810.1186/s13054-017-1659-4Corticosteroids in septic shock: a systematic review and network meta-analysisBen Gibbison0José A. López-López1Julian P. T. Higgins2Tom Miller3Gianni D. Angelini4Stafford L. Lightman5Djillali Annane6Cardiac Anaesthesia and Intensive Care, Bristol Heart Institute – University Hospitals Bristol NHS Foundation Trust, University of BristolSchool of Social and Community Medicine, University of BristolCentre for Research Synthesis and Decision Analysis, School of Social and Community Medicine, University of BristolCardiac Anaesthesia and Intensive Care, Bristol Heart Institute – University Hospitals Bristol NHS Foundation Trust, University of BristolCardiac Surgery, Bristol Heart Institute – University Hospitals Bristol NHS Foundation Trust, University of BristolHenry Wellcome Laboratories for Integrative Neuroscience and Metabolism, School of Clinical Sciences, University of BristolMedicine: Critical Care Medicine, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris (APHP)Abstract 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.http://link.springer.com/article/10.1186/s13054-017-1659-4SepsisCritical careGlucocorticoidsSteroidsAdrenalSeptic shock |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ben Gibbison José A. López-López Julian P. T. Higgins Tom Miller Gianni D. Angelini Stafford L. Lightman Djillali Annane |
spellingShingle |
Ben Gibbison José A. López-López Julian P. T. Higgins Tom Miller Gianni D. Angelini Stafford L. Lightman Djillali Annane Corticosteroids in septic shock: a systematic review and network meta-analysis Critical Care Sepsis Critical care Glucocorticoids Steroids Adrenal Septic shock |
author_facet |
Ben Gibbison José A. López-López Julian P. T. Higgins Tom Miller Gianni D. Angelini Stafford L. Lightman Djillali Annane |
author_sort |
Ben Gibbison |
title |
Corticosteroids in septic shock: a systematic review and network meta-analysis |
title_short |
Corticosteroids in septic shock: a systematic review and network meta-analysis |
title_full |
Corticosteroids in septic shock: a systematic review and network meta-analysis |
title_fullStr |
Corticosteroids in septic shock: a systematic review and network meta-analysis |
title_full_unstemmed |
Corticosteroids in septic shock: a systematic review and network meta-analysis |
title_sort |
corticosteroids in septic shock: a systematic review and network meta-analysis |
publisher |
BMC |
series |
Critical Care |
issn |
1364-8535 |
publishDate |
2017-03-01 |
description |
Abstract 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. |
topic |
Sepsis Critical care Glucocorticoids Steroids Adrenal Septic shock |
url |
http://link.springer.com/article/10.1186/s13054-017-1659-4 |
work_keys_str_mv |
AT bengibbison corticosteroidsinsepticshockasystematicreviewandnetworkmetaanalysis AT josealopezlopez corticosteroidsinsepticshockasystematicreviewandnetworkmetaanalysis AT julianpthiggins corticosteroidsinsepticshockasystematicreviewandnetworkmetaanalysis AT tommiller corticosteroidsinsepticshockasystematicreviewandnetworkmetaanalysis AT giannidangelini corticosteroidsinsepticshockasystematicreviewandnetworkmetaanalysis AT staffordllightman corticosteroidsinsepticshockasystematicreviewandnetworkmetaanalysis AT djillaliannane corticosteroidsinsepticshockasystematicreviewandnetworkmetaanalysis |
_version_ |
1725449170342379520 |