Li Q, Xie J F, Liu L
Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China.
Zhonghua Nei Ke Za Zhi. 2020 Jun 1;59(6):451-459. doi: 10.3760/cma.j.cn112138-20190802-00536.
To evaluate the effect of corticosteroids on the prognosis of patients with septic shock. In order to compare administration of corticosteroids with placebo or standard supportive care in adults with septic shock, clinical randomized controlled trials (RCT) were searched and selected, according to inclusion and exclusion criteria. A systemic assessment and meta-analysis was performed using RevMan 5.3. A total of 16 RCTs enrolling 6 896 patients were finally included in present analysis. The corticosteroids group included 3 448 patients, and the control group included 3 448 patients. The 28-day mortality in corticosteroids group and control group were 28.6% and 31.2%, respectively (0.16). The 90-day mortality, the mortality in intensive care unit (ICU) and the mortality in the hospital between corticosteroids group and control group were 31.7% vs. 34.0% (0.16), 37.5% vs. 37.5% (0.87), and 41.0% vs. 43.9% (0.35) respectively, which indicated that corticosteroids could not improve the mortality of patients with septic shock. Subgroup analyses showed that hydrocortisone combined with hydrocortisone could reduce the 28-day mortality, and the 28-day mortality in corticosteroids group and control group were 37.7% and 43.3%, respectively (0.02). However, other types of corticosteroids had no influence on 28-day mortality. The incidence of gastrointestinal hemorrhage and super-infections showed no statistical difference in corticosteroids group and control group. However, incidence of hyperglycemia was significantly increased in corticosteroids group, 27.1% vs. 25% (0.000 1). Corticosteroids could not improve the mortality of patients with septic shock, and simultaneously, significantly increase incidence of hyperglycemia. Corticosteroids have no influence on the incidence of gastrointestinal hemorrhage and super-infections. Subgroup analyses showed that hydrocortisone combined with hydrocortisone could reduce the 28-day mortality.
评估皮质类固醇对感染性休克患者预后的影响。为比较皮质类固醇与安慰剂或标准支持治疗在感染性休克成年患者中的应用效果，根据纳入和排除标准检索并筛选了临床随机对照试验（RCT）。使用RevMan 5.3进行系统评价和荟萃分析。本分析最终纳入了16项RCT，共6896例患者。皮质类固醇组3448例患者，对照组3448例患者。皮质类固醇组和对照组的28天死亡率分别为28.6%和31.2%（0.16）。皮质类固醇组和对照组的90天死亡率、重症监护病房（ICU）死亡率和医院死亡率分别为31.7%对34.0%（0.16）、37.5%对37.5%（0.87）和41.0%对43.9%（0.35），这表明皮质类固醇不能改善感染性休克患者的死亡率。亚组分析显示，氢化可的松联合氢化可的松可降低28天死亡率，皮质类固醇组和对照组的28天死亡率分别为37.7%和43.3%（0.02）。然而，其他类型的皮质类固醇对28天死亡率没有影响。皮质类固醇组和对照组的胃肠道出血和二重感染发生率无统计学差异。然而，皮质类固醇组的高血糖发生率显著增加，为27.1%对25%（0.0001）。皮质类固醇不能改善感染性休克患者的死亡率，同时显著增加高血糖发生率。皮质类固醇对胃肠道出血和二重感染的发生率没有影响。亚组分析显示，氢化可的松联合氢化可的松可降低28天死亡率。
