Revisioni sistematiche related to this topic

loading
22 References (22 articles) loading Revert Studify

Systematic review

Unclassified

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

Autori Zhu Y , Wen Y , Jiang Q , Guo N , Cai Y , Shen X
Giornale Shock (Augusta, Ga.)
Year 2019
Links Pubmed DOI

Questo articolo contiene 18 Primary studies 18 Primary studies (18 references)

Loading references information
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.

Systematic review

Unclassified

Corticosteroids for treating sepsis in children and adults.

Giornale The Cochrane database of systematic reviews
Year 2019
Links Pubmed DOI PubMed Central

Questo articolo fa parte di 5 Broad syntheses 33 Broad syntheses (5 references)

Questo articolo contiene 33 Primary studies 33 Primary studies (33 references)

Loading references information
BACKGROUND: Sepsis occurs when an infection is complicated by organ failure. Sepsis may be complicated by impaired corticosteroid metabolism. Thus, providing corticosteroids may benefit patients. The original review was published in 2004 and was updated in 2010 and 2015 prior to this update. OBJECTIVES: To examine the effects of corticosteroids on death in children and adults with sepsis. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, LILACS, ClinicalTrials.gov, ISRCTN, and the WHO Clinical Trials Search Portal, on 25 July 2019. In addition, we conducted reference checking and citation searching, and contacted study authors, to identify additional studies as needed. SELECTION CRITERIA: We included randomized controlled trials (RCTs) of corticosteroids versus placebo or usual care (antimicrobials, fluid replacement, and vasopressor therapy as needed) in children and adults with sepsis. We also included RCTs of continuous infusion versus intermittent bolus of corticosteroids. DATA COLLECTION AND ANALYSIS: All review authors screened and selected studies for inclusion. One review author extracted data, which was checked by the others, and by the lead author of the primary study when possible. We obtained unpublished data from the authors of some trials. We assessed the methodological quality of trials and applied GRADE to assess the certainty of evidence. Review authors did not contribute to assessment of eligibility and risk of bias, nor to data extraction, for trials they had participated in. MAIN RESULTS: We included 61 trials (12,192 participants), of which six included only children, two included children and adults, and the remaining trials included only adults. Nine studies are ongoing and will be considered in future versions of this review. We judged 19 trials as being at low risk of bias. Corticosteroids versus placebo or usual care Compared to placebo or usual care, corticosteroids probably slightly reduce 28-day mortality (risk ratio (RR) 0.91, 95% confidence interval (CI) 0.84 to 0.99; 11,233 participants; 50 studies; moderate-certainty evidence). Corticosteroids may result in little to no difference in long-term mortality (RR 0.97, 95% CI 0.91 to 1.03; 6236 participants; 7 studies; low-certainty evidence) and probably slightly reduce hospital mortality (RR 0.90, 95% CI 0.82 to 0.99; 8183 participants; 26 trials; moderate-certainty evidence). Corticosteroids reduced length of intensive care unit (ICU) stay for all participants (mean difference (MD) -1.07 days, 95% CI -1.95 to -0.19; 7612 participants; 21 studies; high-certainty evidence) and resulted in a large reduction in length of hospital stay for all participants (MD -1.63 days, 95% CI -2.93 to -0.33; 8795 participants; 22 studies; high-certainty evidence). Corticosteroids increase the risk of muscle weakness (RR 1.21, 95% CI 1.01 to 1.44; 6145 participants; 6 studies; high-certainty evidence). Corticosteroids probably do not increase the risk of superinfection (RR 1.06, 95% CI 0.95 to 1.19; 5356 participants; 25 studies; moderate-certainty evidence). Corticosteroids increase the risk of hypernatraemia (high-certainty evidence) and probably increase the risk of hyperglycaemia (moderate-certainty evidence). Moderate-certainty evidence shows that there is probably little or no difference in gastroduodenal bleeding, stroke, or cardiac events, and low-certainty evidence suggests that corticosteroids may result in little to no difference in neuropsychiatric events. Continuous infusion of corticosteroids versus intermittent bolus We are uncertain about the effects of continuous infusion of corticosteroids compared with intermittent bolus administration. Three studies reported data for this comparison, and the certainty of evidence for all outcomes was very low. AUTHORS' CONCLUSIONS: Moderate-certainty evidence indicates that corticosteroids probably reduce 28-day and hospital mortality among patients with sepsis. Corticosteroids result in large reductions in ICU and hospital length of stay (high-certainty evidence). There may be little or no difference in the risk of major complications; however, corticosteroids increase the risk of muscle weakness and hypernatraemia, and probably increase the risk of hyperglycaemia. The effects of continuous versus intermittent bolus administration of corticosteroids are uncertain.

Systematic review

Unclassified

Steroids and Survival in Critically Ill Adult Patients: A Meta-analysis of 135 Randomized Trials.

Giornale Journal of cardiothoracic and vascular anesthesia
Year 2018
Links Pubmed DOI www.epistemonikos.org

Questo articolo contiene 134 Primary studies 134 Primary studies (134 references)

Loading references information
OBJECTIVE: Corticosteroids have important effects on intermediate outcomes in critically ill patients, but their effect on survival is unknown. The objective of this meta-analysis was to analyze the effect on mortality of corticosteroids in critical and perioperative settings. DESIGN: A meta-analysis of randomized trials. SETTING: PubMed, Embase, BioMed Central, Google Scholar, and the Cochrane Central Register of Controlled Trials were searched to February 1, 2018, for randomized trials comparing corticosteroids with placebo or standard care. PARTICIPANTS: Critically ill or surgical adult patients. INTERVENTIONS: Corticosteroids compared with placebo or standard care. MEASUREMENTS AND MAIN RESULTS: A total of 44,553 patients from 135 studies were included. Overall, mortality in the corticosteroid group and in the control group were similar (16% v 16%; p = 0.9). Subanalyses identified a beneficial effect of corticosteroids on survival in patients with respiratory system diseases (9% v 13%; p < 0.001) and bacterial meningitis (28% v 32%; p= 0.04), and a detrimental effect on survival in patients with traumatic brain injury (22% v 19%; p < 0.001). No differences in mortality were found in patients with cardiac diseases (7% v 6%; p = 0.7), in patients undergoing cardiac surgery (2.8% v 3.2% p = 0.14), and when treatment duration or patient age were considered. CONCLUSIONS: This meta-analysis documents the safety of corticosteroids in the overall critically ill population with the notable exception of brain injury patients, a setting where the authors confirmed their detrimental effect on survival. A possible beneficial effect of corticosteroids on survival was found among patients with respiratory diseases and in patients with bacterial meningitis.

Systematic review

Unclassified

Low-dose corticosteroids for adult patients with septic shock: a systematic review with meta-analysis and trial sequential analysis.

Giornale Intensive care medicine
Year 2018
Links Pubmed DOI

Questo articolo contiene 22 Primary studies 22 Primary studies (22 references)

Loading references information
PURPOSE: To assess the effect of low dose corticosteroids on outcomes in adults with septic shock. METHODS: We systematically reviewed randomised clinical trials (RCTs) comparing low-dose corticosteroids to placebo in adults with septic shock. Trial selection, data abstraction and risk of bias assessment were performed in duplicate. The primary outcome was short-term mortality. Secondary and tertiary outcomes included longer-term mortality, adverse events, quality of life, and duration of shock, mechanical ventilation and ICU stay. RESULTS: There were 22 RCTs, including 7297 participants, providing data on short-term mortality. In two low risk of bias trials, the relative risk (RR) of short-term mortality with corticosteroid versus placebo was 0.98 [95% confidence interval (CI) 0.89-1.08, p = 0.71]. Sensitivity analysis including all trials was similar (RR 0.96; 95% CI 0.91-1.02, p = 0.21) as was analysis of longer-term mortality (RR 0.96; 95% CI 0.90-1.02, p = 0.18). In low risk of bias trials, the risk of experiencing any adverse event was higher with corticosteroids; however, there was substantial heterogeneity (RR 1.66; 95% CI 1.03-2.70, p = 0.04, I2 = 78%). No trials reported quality of life outcomes. Duration of shock [mean difference (MD) -1.52 days; 95% CI -1.71 to -1.32, p < 0.0001], duration of mechanical ventilation (MD -1.38 days; 95% CI -1.96 to -0.80, p < 0.0001), and ICU stay (MD -0.75 days; 95% CI -1.34 to -0.17, p = 0.01) were shorter with corticosteroids versus placebo. CONCLUSIONS: In adults with septic shock treated with low dose corticosteroids, short- and longer-term mortality are unaffected, adverse events increase, but duration of shock, mechanical ventilation and ICU stay are reduced. PROSPERO registration no. CRD42017084037.

Systematic review

Unclassified

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

Giornale Critical care (London, England)
Year 2017
Links Pubmed DOI PubMed Central

Questo articolo contiene 14 Primary studies 14 Primary studies (14 references)

Loading references information
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.

Systematic review

Unclassified

Adjunctive Corticotherapy for Community Acquired Pneumonia: A Systematic Review and Meta-Analysis.

Giornale PloS one
Year 2015
Links Pubmed DOI PubMed Central

Questo articolo contiene 14 Primary studies 14 Primary studies (14 references)

Loading references information
BACKGROUND: Community-acquired pneumonia (CAP) induces lung and systemic inflammation, leading to high morbidity and mortality. We systematically reviewed the risks and benefits of adjunctive corticotherapy in the management of patients with CAP. METHODS: We systematically searched Pubmed, Embase and the Cochrane Library for randomized controlled trials comparing adjunctive corticotherapy and antimicrobial therapy with antimicrobial therapy alone in patients with CAP. The primary outcome was 30-day mortality. Secondary outcomes were length of hospital stay, time to clinical stability and severe complications. RESULTS: 14 trials (2077 patients) were included. The reported 30-day mortality was 7.9% (80/1018) among patients treated with adjunctive corticotherapy versus 8.3% (85/1028) among patients treated with antimicrobial therapy alone (RR 0.84; 95%CI 0.55 to1.29). Adjunctive corticotherapy was associated with a reduction of severe complications (RR 0.36; 95%CI 0.23 to 0.56), a shorter length of stay (9.0 days; 95%CI 7.6 to 10.7 vs 10.6 days; 95%CI 7.4 to 15.3) and a shorter time to clinical stability (3.3 days; 95% CI 2.8 to 4.1 vs 4.3 days; 95%CI 3.6 to 5.1). The risk of hyperglycemia was higher among patients treated with adjunctive corticotherapy (RR 1.59; 95%CI 1.06 to 2.38), whereas the risk of gastro-intestinal bleeding was similar (RR 0.83; 95%CI 0.35 to 1.93). In the subgroup analysis based on CAP severity, a survival benefit was found among patients with severe CAP (RR 0.47; 95%CI 0.23 to 0.96). CONCLUSION: Adjunctive corticotherapy is associated with a reduction of length of stay, time to clinical stability, and severe complications among patients with CAP, but the effect on mortality remains uncertain.

Systematic review

Unclassified

Corticosteroids for acute bacterial meningitis.

Giornale Cochrane Database of Systematic Reviews
Year 2015
Links Pubmed DOI PubMed Central

Questo articolo fa parte di 5 Broad syntheses 25 Broad syntheses (5 references)

Questo articolo contiene 24 Primary studies 25 Primary studies (24 references)

Loading references information
BACKGROUND: In experimental studies, the outcome of bacterial meningitis has been related to the severity of inflammation in the subarachnoid space. Corticosteroids reduce this inflammatory response. OBJECTIVES: To examine the effect of adjuvant corticosteroid therapy versus placebo on mortality, hearing loss and neurological sequelae in people of all ages with acute bacterial meningitis. SEARCH METHODS: We searched CENTRAL (2015, Issue 1), MEDLINE (1966 to January week 4, 2015), EMBASE (1974 to February 2015), Web of Science (2010 to February 2015), CINAHL (2010 to February 2015) and LILACS (2010 to February 2015). SELECTION CRITERIA: Randomised controlled trials (RCTs) of corticosteroids for acute bacterial meningitis. DATA COLLECTION AND ANALYSIS: We scored RCTs for methodological quality. We collected outcomes and adverse effects. We performed subgroup analyses for children and adults, causative organisms, low-income versus high-income countries, time of steroid administration and study quality. MAIN RESULTS: We included 25 studies involving 4121 participants (2511 children and 1517 adults; 93 mixed population). Four studies were of high quality with no risk of bias, 14 of medium quality and seven of low quality, indicating a moderate risk of bias for the total analysis. Nine studies were performed in low-income countries and 16 in high-income countries.Corticosteroids were associated with a non-significant reduction in mortality (17.8% versus 19.9%; risk ratio (RR) 0.90, 95% confidence interval (CI) 0.80 to 1.01, P value = 0.07). A similar non-significant reduction in mortality was observed in adults receiving corticosteroids (RR 0.74, 95% CI 0.53 to 1.05, P value = 0.09). Corticosteroids were associated with lower rates of severe hearing loss (RR 0.67, 95% CI 0.51 to 0.88), any hearing loss (RR 0.74, 95% CI 0.63 to 0.87) and neurological sequelae (RR 0.83, 95% CI 0.69 to 1.00).Subgroup analyses for causative organisms showed that corticosteroids reduced mortality in Streptococcus pneumoniae (S. pneumoniae) meningitis (RR 0.84, 95% CI 0.72 to 0.98), but not in Haemophilus influenzae (H. influenzae) orNeisseria meningitidis (N. meningitidis) meningitis. Corticosteroids reduced severe hearing loss in children with H. influenzae meningitis (RR 0.34, 95% CI 0.20 to 0.59) but not in children with meningitis due to non-Haemophilus species.In high-income countries, corticosteroids reduced severe hearing loss (RR 0.51, 95% CI 0.35 to 0.73), any hearing loss (RR 0.58, 95% CI 0.45 to 0.73) and short-term neurological sequelae (RR 0.64, 95% CI 0.48 to 0.85). There was no beneficial effect of corticosteroid therapy in low-income countries.Subgroup analysis for study quality showed no effect of corticosteroids on severe hearing loss in high-quality studies.Corticosteroid treatment was associated with an increase in recurrent fever (RR 1.27, 95% CI 1.09 to 1.47), but not with other adverse events. AUTHORS' CONCLUSIONS: Corticosteroids significantly reduced hearing loss and neurological sequelae, but did not reduce overall mortality. Data support the use of corticosteroids in patients with bacterial meningitis in high-income countries. We found no beneficial effect in low-income countries.

Systematic review

Unclassified

Glucocorticosteroids for sepsis: systematic review with meta-analysis and trial sequential analysis.

Giornale Intensive care medicine
Year 2015
Links Pubmed DOI PubMed Central

Questo articolo fa parte di 1 Broad synthesis 35 Broad syntheses (1 reference)

Questo articolo contiene 35 Primary studies 35 Primary studies (35 references)

Loading references information
INTRODUCTION: Glucocorticosteroids (steroids) are widely used for sepsis patients. However, the potential benefits and harms of both high and low dose steroids remain unclear. A systematic review of randomised clinical trials with meta-analysis and trial sequential analysis (TSA) might shed light on this clinically important question. METHODS: A systematic review was conducted according to a published protocol and The Cochrane Handbook methodology including meta-analyses, TSA of randomised clinical trials, and external validity estimation (GRADE). Randomised clinical trials evaluating steroids were included for sepsis patients (systemic inflammatory response syndrome, sepsis, severe sepsis or septic shock) aged >18 years. Cochrane Central Register of Controlled Trials (CENTRAL), PubMed/Medline, Embase, Web of Science and Cinahl were searched until 18 February 2015. No language restrictions were applied. Primary outcomes were mortality at longest follow-up and serious adverse events. RESULTS: A total of 35 trials randomising 4682 patients were assessed and reviewed in full text. All trials but two had high risk of bias. No statistically significant effect was found for any dose of steroids versus placebo or no intervention on mortality at maximal follow-up [relative risk (RR) 0.89; TSA adjusted confidence interval (CI) 0.74-1.08]. Two trials with low risk of bias also showed no statistically significant difference (random-effects model RR 0.38, 95 % CI 0.06-2.42). Similar results were obtained in subgroups of trials stratified according to high (>500 mg) or low (≤500 mg) dose hydrocortisone (or equivalent) (RR 0.87; TSA-adjusted CI 0.38-1.99; and RR 0.90; TSA-adjusted CI 0.49-1.67, respectively). There were also no statistically significant effects on serious adverse events other than mortality (RR 1.02; TSA-adjusted CI 0.7-1.48). The effects did not vary according to the degree of sepsis. TSA showed that many more randomised patients are needed before definitive conclusions may be drawn. CONCLUSION: Evidence to support or negate the use of steroids in any dose in sepsis patients is lacking. The results of ongoing and future well-designed, large randomised clinical trials are needed.

Systematic review

Unclassified

Esplorare l'eterogeneità degli effetti dei corticosteroidi sulla sindrome acuta da distress respiratorio: una revisione sistematica ed una meta-analisi.

automatic
Autori Ruan SY , Lin HH , Huang CT , Kuo PH , Wu HD , Yu CJ
Giornale Critical care (London, England)
Year 2014
Links Pubmed DOI PubMed Central

Questo articolo contiene 18 Primary studies 18 Primary studies (18 references)

Loading references information
INTRODUZIONE: L'efficacia della terapia con corticosteroidi sulla mortalità della sindrome da distress respiratorio (ARDS) rimane in discussione. Abbiamo puntato a scoprire i motivi per i risultati incoerenti in studi precedenti e aggiornare le prove. METODI: Abbiamo cercato MEDLINE, Cochrane Central Register of Controlled Trials e Web of Science fino al dicembre 2013. Studi eleggibili inclusi studi clinici randomizzati (RCT) e studi di coorte che riportati mortalità e che aveva non utilizzatori di corticosteroidi per il confronto. L'effetto dei corticosteroidi sulla mortalità ARDS è stato valutato dal rischio relativo (RR) e la differenza di rischio (RD) per ICU, ospedale, e la mortalità di 60 giorni utilizzando un modello ad effetti casuali. RISULTATI: Otto RCT e 10 studi di coorte sono stati inclusi per l'analisi. In RCT, i corticosteroidi hanno avuto un effetto possibile, ma statisticamente significativo sulla mortalità ICU (RD, -0,28; 95% intervallo di confidenza (IC), -0,53 a -0,03 e RR, 0,55; 95% CI, 0,24-1,25), ma nessun effetto sulla 60 giorni di mortalità (RD, -0.01; 95% CI, -0.12 a 0.10 e RR, 0,97; 95% CI, 0,75-1,26). In studi di coorte, i corticosteroidi hanno avuto alcun effetto sulla mortalità ICU (RR, 1,05; 95% CI, 0,74-1,49), ma non significativamente aumentato di 60 giorni la mortalità (RR, 1,30; 95% CI, 0,96-1,78). Nell'analisi dei sottogruppi per ARDS eziologia, corticosteroidi sono aumentate in modo significativo la mortalità in ARDS da influenza (tre studi di coorte, RR, 2,45, 95% CI, 1,40-4,27). CONCLUSIONI: Gli effetti dei corticosteroidi sulla mortalità di ARDS differivano per durata delle misure di outcome e eziologie. I corticosteroidi non ha migliorato i risultati a lungo termine e può causare danni in alcuni sottogruppi. I dati attuali non supportano l'uso di routine dei corticosteroidi in ARDS. Sono necessari ulteriori studi clinici per specificare i sottogruppi favorevoli e sfavorevoli per la terapia con corticosteroidi.

Systematic review

Unclassified

Il ruolo di desametasone nel trattamento della meningite batterica - una revisione sistematica.

automatic
Autori Borchorst S , Møller K
Giornale Acta anaesthesiologica Scandinavica
Year 2012
Links Pubmed DOI

Questo articolo fa parte di 1 Broad synthesis 42 Broad syntheses (1 reference)

Questo articolo contiene 44 Primary studies 42 Primary studies (44 references)

Loading references information
Corticosteroidi sono usati in aggiunta agli antibiotici nel trattamento della meningite batterica nel tentativo di attenuare la risposta infiammatoria intratecale e quindi riducono la mortalità e morbilità. Lo scopo del presente lavoro è fornire una rassegna degli studi clinici di corticosteroidi nel trattamento della meningite batterica. Letteratura Rilevante è stato trovato in PubMed, i database Cochrane, e riferimenti a studi. Quarantaquattro pubblicazioni di rilevanza sono stati identificati, che comprende 29 pubblicazioni di studi randomizzati, 10 pubblicazioni che riportano studi o non o quasi randomizzati, e cinque riportano studi retrospettivi, e nove meta-analisi. Nel loro insieme, il trattamento desametasone può essere associato ad una più bassa mortalità negli adulti e meno sequele neurologiche e uditiva negli adulti e nei bambini dai paesi ad alto reddito, in particolare negli adulti affetti da meningite pneumococcica. Al contrario, gli studi condotti nei paesi in via di sviluppo hanno dato risultati meno favorevoli.