Corticosteroids for treating sepsis

Abstract

BackgroundSepsis occurs when an infection is complicated by organ failures as defined by a sequential organ failure assessment (SOFA) score of two or higher. Sepsis may be complicated by impaired corticosteroid metabolism. Giving corticosteroids may benefit patients. The original review was published in 2004 and was updated in 2010 and again in 2015. ObjectivesTo examine the effects of corticosteroids on death at one month in patients with sepsis, and to examine whether dose and duration of corticosteroids influence patient response to this treatment.

Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017

“…Sepsis and septic shock are major healthcare problems: they affect millions of people worldwide annually and are associated with mortality rates of 25-30% and high direct and indirect costs [35][36][37][38][39]. Pro-inflammatory cytokines have been demonstrated to either suppress cortisol response to ACTH or compete with intracellular glucocorticoid function, which can result in CIRCI in septic patients.…”

“…Analysis of 27 RCTs (n = 3176) of patients with sepsis with and without shock revealed a 28-day mortality rate of 29.3% in patients receiving corticosteroids compared with 31.8% in those who received placebo [relative risk (RR) 0.87, 95% CI 0.76-1.0] [42]. The quality of evidence was considered low owing to inconsistency in the results and imprecision.…”

“…A separate analysis of six RCTs (n = 826) of patients with sepsis without shock revealed a 28-day mortality rate of 33.8% in patients receiving corticosteroids compared with 30.6% in those who received placebo (RR 1.11, 95% CI 0.91-1.34) [42]. Hyperglycemia was the most common adverse event, and corticosteroids did not increase the risk of secondary infections (RR 1.02, 95% CI 0.87-1.20).…”

“…The latest Cochrane systematic review of the use of lowdose hydrocortisone for treating septic shock, including 33 RCTs with a total of 4268 patients [42], showed that corticosteroids significantly reduced the risk of death at 28 days compared with placebo. Three of these RCTs included children and the other 30 trials included only adults.…”

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

“…Both reviews, however, confirmed the improved shock reversal by using low-dose hydrocortisone. More recently, Annane et al included 33 eligible trials (n = 4268) in a new systematic review [304]. Of these 33 trials, 23 were at low risk of selection bias; 22 were at low risk of performance and detection bias; 27 were at low risk of attrition bias; and 14 were at low risk of selective reporting.…”