The Effectiveness and Safety of Corticosteroids Therapy in Adult Critical Ill Patients with Septic Shock: A Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE:

To investigate the effectiveness and safety of corticosteroids therapy in adult critical ill patients with septic shock.

METHODS:

The PUBMED, EMBASE, Web of Science, Cochrane Library databases were systematically searched from the inception dates to March 24, 2018. To identify randomized controlled trials that evaluating the role of corticosteroids therapy in adult critical ill patients with septic shock. The primary outcome was 28-day mortality. The second outcomes included 90-day mortality, ICU mortality, In-hospital mortality, length of stay in ICU, length of stay in hospital, reversal of shock and superinfection.

RESULTS:

A total of eighteen randomized controlled trials involving 8128 adult critical ill patients with septic shock fulfilled the inclusion criteria. The outcomes of this meta-analysis showed that corticosteroids therapy didn't significantly reduce the 28-day mortality [RR = 0.94; 95%CI, 0.84 to 1.05; Z = 1.07(P = 0.285)]. However, corticosteroids therapy was associated with a significantly shorter length of stay in ICU [WMD = -1.55; 95%CI, -2.19 to -0.91; Z = 4.74(P = 0.000)]. 90-day mortality, ICU mortality, In-hospital mortality, length of stay in hospital, reversal of shock and superinfection had no significantly difference between the corticosteroids therapy and placebo therapy(p > 0.05). Similar results were obtained in subgroups of trials stratified according to the dose of corticosteroids (high dose or low does).

CONCLUSIONS:

Based on the results of this meta-analysis, corticosteroids therapy was associated with a significantly shorter length of stay in ICU among adult cirtical ill patients with septic shock. The mortality was similar between the corticosteroids therapy and placebo.