Patient-Level Meta-Analysis of Low-Dose Hydrocortisone in Adults with Septic Shock

Romain Pirracchio; Djillali Annane; Andre K Waschka; François Lamontagne; Yaseen M Arabi; Pierre-Edouard Bollaert; Laurent Billot; Bin Du; Josef Briegel; Jeremy Cohen; Simon Finfer; Anthony Gordon; Naomi Hammond; Herve Hyvernat; Didier Keh; Yi Li; Ling Liu; Gianfranco Umberto Meduri; Liliana Mirea; John A Myburgh; Charles L Sprung; Neijla Tilouche; Surat Tongyoo; Balasubramanian Venkatesh; Ruiqiang Zheng; Anthony Delaney

doi:10.1056/EVIDoa2300034

Patient-Level Meta-Analysis of Low-Dose Hydrocortisone in Adults with Septic Shock

NEJM Evid. 2023 Jun;2(6):EVIDoa2300034. doi: 10.1056/EVIDoa2300034. Epub 2023 May 22.

Authors

Romain Pirracchio¹, Djillali Annane^{2

3

4}, Andre K Waschka^{5

6}, François Lamontagne^{7

8}, Yaseen M Arabi⁹, Pierre-Edouard Bollaert¹⁰, Laurent Billot¹¹, Bin Du¹², Josef Briegel¹³, Jeremy Cohen¹⁴, Simon Finfer^{11

15}, Anthony Gordon¹⁶, Naomi Hammond^{11

17}, Herve Hyvernat¹⁸, Didier Keh¹⁹, Yi Li^{20

21}, Ling Liu²², Gianfranco Umberto Meduri²³, Liliana Mirea²⁴, John A Myburgh¹¹, Charles L Sprung²⁵, Neijla Tilouche²⁶, Surat Tongyoo²⁷, Balasubramanian Venkatesh^{11

28}, Ruiqiang Zheng²⁹, Anthony Delaney^{11

30

31}

Affiliations

¹ Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco.
² General Intensive Care Unit, Raymond Poincaré Hospital (APHP), Garches, France.
³ School of Medicine Simone Veil, University Paris Saclay-Campus UVSQ, Paris.
⁴ FHU SEPSIS, U1173, University Paris Saclay, INSERM, Paris.
⁵ Department of Statistics, University of California Berkeley, Berkeley.
⁶ Department of Mathematics, Mercer University, Macon, Georgia.
⁷ Département de médecine interne, Université de Sherbrooke, Sherbrooke, QC, Canada.
⁸ Centre de recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada.
⁹ Intensive Care Department, Ministry of the National Guard-Health Affairs, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
¹⁰ Intensive Care Unit, Hospital Central, Nancy, France.
¹¹ The George Institute for Global Health, University of New South Wales Sydney, Sydney.
¹² State Key Laboratory of Complex Severe and Rare Diseases, Medical ICU, Peking Union Medical College Hospital, Beijing.
¹³ Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany.
¹⁴ Intensive Care Unit, The Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, QLD, Australia.
¹⁵ School of Public Health, Imperial College London, London.
¹⁶ Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London.
¹⁷ Newtown, NSW, Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St. Leonards, NSW, Australia.
¹⁸ Intensive Care Unit, Hôpital ARCHET 1-CHU de Nice, Nice, France.
¹⁹ Klinik für Anästhsiologie m.S. Canpus Virchow-Klinikum, Charite University Berlin, Berlin.
²⁰ Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing.
²¹ Chinese Academy of Medical Science and Peking Union Medical College, Beijing.
²² Department of Critical Medicine, Zhong-Da Hospital, and School of Clinical Medicine, Southeast University, Nanjing, China.
²³ Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, Memphis.
²⁴ Anaesthesia and Intensive Care Clinic, Clinical Emergency Hospital of Bucharest, Carol Davila University of Medicine, Bucharest, Romania.
²⁵ Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem.
²⁶ Intensive Care Unit, University Hospital Taher Sfar Mahdia, University of Monastir, Research Laboratory, Monastir, Tunisia.
²⁷ Division of Critical Care, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
²⁸ Wesley Hospital, George Institute for Global Health, University of New South Wales, Sydney.
²⁹ Department of Critical Care Medicine, Northern Jiangsu People's Hospital; Clinical Medical College, Yangzhou University, Yangzhou, China.
³⁰ Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney.
³¹ Northern Clinical School, Sydney Medical School, University of Sydney, Sydney.

PMID: 38320130
DOI: 10.1056/EVIDoa2300034

Abstract

Low-Dose Hydrocortisone and Septic ShockCorticosteroids have been evaluated as a therapy for septic shock for more than 50 years. However, uncertainty persists about their effects on mortality. Pirracchio and colleagues undertake a patient-level meta-analysis to answer this important question.

Publication types

Meta-Analysis

MeSH terms

Adult
Humans
Hydrocortisone*
Shock, Septic* / drug therapy

Substances

Hydrocortisone