The administration of corticosteroids in patients with sepsis may be associated with significant improvement in healthcare outcomes, according to study results published in JAMA Internal Medicine.
Sepsis is defined as a life-threatening host response to an infection that may culminate in organ failure and death. Sepsis occurs with an incidence of 535 cases per 100,000 person-years. In-hospital mortality in sepsis ranges from 30% to 45%. Along with antibiotic administration and early respiratory and hemodynamic support, corticosteroids have been widely used in adults with sepsis as adjuvant therapy, however, the overall benefit and potential risks are not clear. This uncertainty regarding the efficacy of corticosteroids in patients with sepsis has resulted in a wide variation in clinical practice. Therefore, this study conducted a systemic review and meta-analysis of the efficacy and safety of corticosteroids in patients with sepsis.
Researchers searched the databases of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for the following terms, alone or in combination: corticosteroids, sepsis, septic shock, hydrocortisone, controlled trials, and randomized controlled trials. The study included a total of 37 randomized clinical trials (RCTs; N=9564 patients) were included that compared administration of corticosteroids with placebo or standard supportive care in adults with sepsis were included in the study; 11 of these trials were rated as low risk for bias. A random-effects model was used to calculate risk ratios and mean differences, and meta‑analyses were conducted. Citation screening, data abstraction, and risk assessment were completed by 2 independent reviewers.
Results suggested that corticosteroid administration may be associated with reduced 28-day mortality (risk ratio, 0.90), intensive care unit mortality (risk ratio, 0.85), and in-hospital mortality (risk ratio, 0.88) when compared with standard supportive care or placebo use. Further, corticosteroids were significantly associated with increased shock reversal at day 7 (mean difference, 1.95) and vasopressor-free days (mean difference, 1.95), along with length of stay in intensive care units (mean difference, −1.16), and time to resolution of shock (mean difference, −1.35). No associations between significant adverse effects and corticosteroid treatment were found when comparing rates of gastroduodenal bleeding, superinfection, or any severe adverse event. However, corticosteroid administration was associated with an increased risk for hypernatremia (risk ratio, 1.57) and hyperglycemia (risk ratio, 1.19).
Overall, the study authors concluded that, “The findings suggest that corticosteroid therapy compared with standard supportive care or placebo is significantly associated with reduced 28-day mortality in patients with sepsis.”
Fang F, Zhang Y, Tang J, et al. Association of corticosteroid treatment with outcomes in adult patients with sepsis: a systemic review and meta-analysis [published online December 21, 2019]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.5849