Xu Rui, Wang Qian, Huang Yan, Wu Ling, Liu Qi, Hu Wei, Zhou Chengfu, Du Quan
1 Department of Anesthesiology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.
2 Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
J Int Med Res. 2018 Jul;46(7):2513-2524. doi: 10.1177/0300060518774985. Epub 2018 Jun 18.
Objective This meta-analysis with trial sequential analysis (TSA) was performed to determine whether low-dose corticosteroids (LDCs) can improve survival or shock reversal from septic shock in adults. Methods A literature search was performed using several databases (Medline, Cochrane Library, Embase, and Chinese Biological Medical Database) until 23 October 2017. The systematic review was registered in PROSPERO. Results Nine randomized controlled trials (RCTs) (n = 1182) were included. LDC intervention improved 7-day shock reversal compared with the control group (relative risk, 1.36; TSA-adjusted 95% confidence interval, 1.20-1.54). LDCs had no statistically significant effects on gastrointestinal bleeding or superinfection. LDCs did not reduce 28-day mortality from septic shock (relative risk, 0.96; TSA-adjusted 95% confidence interval, 0.74-1.24). The TSA indicated that RCTs of about 3000 patients would be needed to draw definitive conclusions; similar results were obtained in a subgroup analysis of nonresponders. Conclusions LDCs improve 7-day shock reversal. However, whether LDCs improve 28-day survival from septic shock in adults remains unclear. The results of well-designed larger RCTs are needed.
目的 进行这项采用序贯试验分析（TSA）的荟萃分析，以确定低剂量皮质类固醇（LDCs）能否提高成人感染性休克患者的生存率或逆转休克状态。方法 使用多个数据库（Medline、Cochrane图书馆、Embase和中国生物医学数据库）进行文献检索，检索截至2017年10月23日。该系统评价已在国际前瞻性系统评价注册库（PROSPERO）登记。结果 纳入9项随机对照试验（RCTs）（n = 1182）。与对照组相比，LDC干预改善了7天的休克逆转情况（相对危险度，1.36；TSA调整后的95%置信区间，1.20 - 1.54）。LDCs对胃肠道出血或二重感染无统计学显著影响。LDCs未降低感染性休克患者的28天死亡率（相对危险度，0.96；TSA调整后的95%置信区间，0.74 - 1.24）。TSA表明，大约需要3000例患者的RCTs才能得出明确结论；在无反应者的亚组分析中也获得了类似结果。结论 LDCs可改善7天的休克逆转情况。然而，LDCs是否能提高成人感染性休克患者的28天生存率仍不明确。需要设计良好的更大规模RCTs的结果。
