Septic shock and severe sepsis: Corticosteroids for acute treatment
DISEASE INTERVENTION COMPARISON RESULTS
Crit Care Med. 1995 Aug;23(8):1430-9 Systematic Review
IN sepsis, septic shock The Use of
corticosteroids
As Treatment, Acute
Is worse Than
placebo
To reduce mortality: trend toward increased mortality (relative risk 1.13, p NS) with corticosteroids
Cochrane Database Syst Rev. 2004;(1):CD002243 Systematic Review, Cochrane Review
IN sepsis, septic shock The Use of
corticosteroids, 5 days course of low dose (300 mg hydrocortisone)
As Treatment, Acute
Is better Than
placebo
To increase the proportion of shock reversal and red uce mortality at day 28. No increase of gastroduodenal bleeding, hyperglycaemia or superainfection.
Ann Intern Med. 2004 Jul 6;141(1):47-56 Meta-Analysis
IN sepsis, septic shock The Use of
corticosteroids, 7 days course of lower doses (1 200 mg hydrocortisone equivalents)
As Treatment, Acute
Is better Than
placebo orshort course of high-dose corticosteroids
To reduce mortality (relative benefit 1.23) and improve shock reversal (relative benefit 1.71)
JAMA. 2009 Jun 10;301(22):2362-75 Meta-Analysis
IN sepsis, septic shock The Use of
corticosteroids, a several days course of low dose
As Treatment, Acute
Is better Than
placebo
To reduce 28-day mortality: 37.5% corticoids VS 44% placebo. Corticoids increased hyperglycaemia and hyponatremia, but not superinfection or gastroduocenal bleeding.
N Engl J Med. 2008 Jan 10;358(2):111-24 Randomized Controlled Trial, Multicenter Study
IN sepsis, septic shock The Use of
corticosteroids, hydrocortisone (50 mg/6h for 5 days and tapering)
As Treatment, Acute
Is equal Than
placebo
To reduce mortality at 4 weeks (39% hydrocortisone VS 36% placebo)
N Engl J Med. 2018 Mar 1;378(9):809-818 Randomized Controlled Trial, Multicenter Study
IN sepsis, septic shock The Use of
corticosteroids, hydrocortisone plus fludrocortisone for 7 days (hydrocortisone 50mg IV /6 hours, fludrocortisone 50μg /d PO/SNG)
As Treatment, Acute
Is better Than
placebo
To reduce death at 3 months: 43% cortics VS 49% placebo. Rate of serious adverse events did not differ significantly, except hyperglycemia.