Impact on Efficacy and Safety of Hydrocortisone in Sepsis and Septic Shock - A Systematic Literature Review and Meta-analysis.

Autor: Aletreby WT; Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia., Alharthy AM; Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia., Madi AF; Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia.; Anesthesia Department, Faculty of Medicine, Tanta University, Tanta, Egypt., Soliman IR; Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia., Hamido HM; Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia., Ramadan OE; Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia.; Anesthesia Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt., Alzayer W; Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia., Huwait BM; Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia., Alodat MA; Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia., Mumtaz SA; Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia., Mahmood NN; Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia., Al Kurdi MH; Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia., Farrag HA; Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia., Karakitsos D; Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia.; Department of Critical Care, Keck Medical School, USC, Los Angeles, CA, USA.
Jazyk: angličtina
Zdroj: Archives of Iranian medicine [Arch Iran Med] 2019 Jul 01; Vol. 22 (7), pp. 394-402. Date of Electronic Publication: 2019 Jul 01.
Abstrakt: Background: Sepsis and septic shock are major causes of morbidity and mortality worldwide, associated with a high economic and social burden on healthcare systems and communities, yet with few definite treatment modalities. The efficacy of steroids in the management of sepsis or septic shock remains a controversy and subject of investigation due to their theoretical beneficial effects.
Methods: This was a systematic literature review and meta-analysis on randomized controlled trials of hydrocortisone usage in sepsis or septic shock as of 2000, following the GRADE methodology, considering a primary outcome of 28 day all-cause mortality.
Results: Ten randomized control trials were included in the review, 9 of which reported 28 day mortality either as a primary or secondary outcome. Relative risk of dying at 28 days was 0.93 in favor of hydrocortisone (95% CI: 0.86-1.01; P = 0.056). Other secondary outcomes of the review were similarly statistically insignificant. The quality of evidence was graded as very low to low.
Conclusion: Hydrocortisone, when used in sepsis or septic shock, in critically ill adult patients showed a statistically insignificant trend towards decreasing 28 day all-cause mortality. This warrants consideration of clinical significance for each patient individually.
(© 2019 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)
Databáze: MEDLINE
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