Clinical Question: Does long-term t...

Clinical Question: Does long-term treatment with low-dose corticosteroids decrease mortality caused by means of severe sepsis or septic shock?

Setting: Inpatient (intensive care unit only)

thought Design: Meta-analysis (other)

Synopsis: A previous meta-analysis has shown that high-dose, short-term corticosteroids do not propose a benefit in patients with chaste sepsis or septic shock (Crit Care M 1995;23:1294-303) In this meta-analysis, investigators reexamined whether high-dose, short-term corticosteroids tender any benefit in patients with unadorned sepsis or septic shock and also direct the eyeed at the role of low-dose, long-term steroids. The authors searched several databases for potential studies, dividing into pairs to determine the eligibility of each research Four reviewers independently abstracted the data, contacting authors for missing data when necessary. They identified 16 randomized or quasi-randomized studies evaluating a combined 2063 patients. principally studies were double-blind and had adequate concealment of allocation. High-dose, short-term therapy, which was defined as more than 300 mg of hydrocortisone for les than five days, had no tenor on mortality rates at 28 days. However, in the five trials with low-dose (i.e., 300 mg or less) long-term steroids, all-cause mortality was approximately 20 percent les in the treated patients (relative risk = 08; 95 percent confidence interval [CI], 067 to 095) common death would be prevented for each nine patients treated with long-term courses of low-dose steroids instead of no additional treatment (number wanted to treat [NNT] = 88; 95 percent CI, 54 to 357) Mortality rates in the intensive care unit also were lower (NNT = 91; 95 percent CI, 55 to 55) Steroid treatment did not increase the risk of gastrointestinal bleeding, super infections, and hyperglycemia.

Bottom Line: Although high doses of corticosteroids are ineffective for the treatment of austere sepsis or septic shock, les than 300 mg of hydrocortisone given for at least five days decreases short-term and long-term mortality rates. (Level of Evidence: 1a-)

investigation Reference: Annane D, et al. Corticosteroids for methodical sepsis and septic shock: a systematic review and meta-analysis. BMJ August 28 2004;329:480

Used with permission from Shaughnessy AF. Short-term steroids effective for sepsis. Accessed online November 1 2004 at: http://www.InfoPOEMs.com.

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