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皮质类固醇在治疗危重症脓毒症患者中的作用:荟萃分析综述。

Role of corticosteroids in the treatment of critically ill sepsis patients: a meta-analysis review.

机构信息

Department of Emergency/Critical Care Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, Jiangsu, China.

出版信息

Inflammopharmacology. 2024 Apr;32(2):965-974. doi: 10.1007/s10787-023-01426-3. Epub 2024 Feb 12.

Abstract

OBJECTIVE

It was to systematically evaluate the effect of corticosteroids on 28d all-cause mortality (ACM), in-hospital death rate, and ICU death rate in critically ill sepsis patients.

METHODS

PubMed, Embase, and Medline databases were used to screen the published literatures on the therapeutic effect of corticosteroids in the treatment of critically ill sepsis patients. After evaluating the quality of the included literatures, RevMan 5.3 software was used for meta-analysis. 4524 literatures regarding the application of corticosteroids to treat critically ill sepsis patients were preliminarily searched. After screening was carried out, 9 literatures were finally included. 2,850 patients were treated with corticosteroids and 2867 patients were treated with placebo.

RESULTS

The meta-analysis of the effect of corticosteroids versus placebo on 28dACM showed [OR = 0.87, 95% CI 0.78-0.98, Z = 2.22, P = 0.03], P < 0.05; the meta-analysis of the outcome of corticosteroids versus placebo on ICU death rate showed [OR = 0.77, 95% CI 0.63-0.94, Z = 2.60, P = 0.009], P < 0.05; and the meta-analysis of the effect of corticosteroids versus placebo on in-hospital death rate showed [OR = 0.80, 95% CI 0.66-0.96, Z = 2.34, P = 0.002], P < 0.05.

CONCLUSION

In summary, corticosteroids can reduce the death rate of critically ill sepsis patients to a certain extent and have good clinical application value.

摘要

目的

系统评价皮质类固醇对重症脓毒症患者 28 天全因死亡率(ACM)、住院死亡率和 ICU 死亡率的影响。

方法

检索 PubMed、Embase 和 Medline 数据库中关于皮质类固醇治疗重症脓毒症患者的疗效的已发表文献,对纳入文献进行质量评价后,采用 RevMan 5.3 软件进行 Meta 分析。初步检索皮质类固醇治疗重症脓毒症患者的相关文献 4524 篇,筛选后最终纳入 9 篇文献,其中 2850 例患者接受皮质类固醇治疗,2867 例患者接受安慰剂治疗。

结果

皮质类固醇与安慰剂对 28dACM 影响的 Meta 分析结果显示[OR=0.87,95%CI 0.78-0.98,Z=2.22,P=0.03],P<0.05;皮质类固醇与安慰剂对 ICU 死亡率结局的 Meta 分析结果显示[OR=0.77,95%CI 0.63-0.94,Z=2.60,P=0.009],P<0.05;皮质类固醇与安慰剂对住院死亡率影响的 Meta 分析结果显示[OR=0.80,95%CI 0.66-0.96,Z=2.34,P=0.002],P<0.05。

结论

综上所述,皮质类固醇可在一定程度上降低重症脓毒症患者的死亡率,具有良好的临床应用价值。

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