Corticosteroids for Treating Sepsis in Adult Patients: A Systematic Review and Meta-Analysis

Huoyan Liang; Heng Song; Ruiqing Zhai; Gaofei Song; Hongyi Li; Xianfei Ding; Quancheng Kan; Tongwen Sun

doi:10.3389/fimmu.2021.709155

Corticosteroids for Treating Sepsis in Adult Patients: A Systematic Review and Meta-Analysis

Front Immunol. 2021 Aug 16:12:709155. doi: 10.3389/fimmu.2021.709155. eCollection 2021.

Authors

Huoyan Liang^{1

2}, Heng Song^{1

2}, Ruiqing Zhai³, Gaofei Song^{1

2}, Hongyi Li^{1

2}, Xianfei Ding¹, Quancheng Kan⁴, Tongwen Sun^{1

2}

Affiliations

¹ General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, China.
² Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China.
³ College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China.
⁴ Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Abstract

Objective: Corticosteroids are a common option used in sepsis treatment. However, the efficacy and potential risk of corticosteroids in septic patients have not been well assessed. This review was performed to assess the efficacy and safety of corticosteroids in patients with sepsis.

Methods: PubMed, Embase, and Cochrane library databases were searched from inception to March 2021. Randomized controlled trials (RCTs) that evaluated the effect of corticosteroids on patients with sepsis were included. The quality of outcomes in the included articles was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation methodology. The data were pooled by using risk ratio (RR) and mean difference (MD). The random-effects model was used to evaluate the pooled MD or RR and 95% confidence intervals (CIs).

Results: Fifty RCTs that included 12,304 patients with sepsis were identified. Corticosteroids were not associated with the mortality in 28-day (RR, 0.94; 95% CI, 0.87-1.02; evidence rank, moderate) and long-term mortality (>60 days) (RR, 0.96; 95% CI, 0.88-1.05) in patients with sepsis (evidence rank, low). However, corticosteroids may exert a significant effect on the mortality in the intensive care unit (ICU) (RR, 0.9; 95% CI, 0.83-0.97), in-hospital (RR, 0.9; 95% CI, 0.82-0.99; evidence rank, moderate) in patients with sepsis or septic shock (evidence rank, low). Furthermore, corticosteroids probably achieved a tiny reduction in the length of hospital stay and ICU. Corticosteroids were associated with a higher risk of hypernatremia and hyperglycemia; furthermore, they appear to have no significant effect on superinfection and gastroduodenal bleeding.

Conclusions: Corticosteroids had no significant effect on the 28-day and long-term mortality; however, they decreased the ICU and hospital mortality. The findings suggest that the clinical corticosteroids may be an effective therapy for patients with sepsis during the short time.

Systematic review registration: https://inplasy.com/wp-content/uploads/2021/05/INPLASY-Protocol-1074-4.pdf.

Keywords: corticosteroids; meta-analysis; mortality; sepsis; systematic review.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Adrenal Cortex Hormones / adverse effects
Adrenal Cortex Hormones / therapeutic use*
Adult
Hospital Mortality
Humans
Intensive Care Units
Sepsis / drug therapy*
Sepsis / mortality

Substances

Adrenal Cortex Hormones