Efficacy And Safety Assessment Of Corticosteroids For Sepsis And Sepsis Shock

Objective:To evaluate the efficacy,safety and optimal treatment of low-dose glucocorticosteroids for adult sepsis and septic shock.Methods:Computer retrieval database of Pub Med,Enbase,Cochrane library,Wanfang,CNKI,CBM,and VIP.Search terms and free terms are determined by extensive literature review and Me SH database(see Appendix Pub Med Search Strategy for details).A randomized controlled trial to search for glucocorticoid versus conventional therapy orplacebo versus conventional therapy in adult patients with sepsis and septic shock.Ranging from 2000 to10 February 2020,and updated on 8 November 2020.Two researchers independently searched articles,extracted data,and assessed the quality of inclusion.The data were analyzed with Eev Man 5.3 software.Results:Included in 16 randomized controlled trials involving 7,553adults with sepsis,the results showed that low-dose corticosteroids significantly reduced the 28-day mortality(OR,0.87[0.79,0.97],I~2=0%,P=0.01),ICU mortality(OR,0.81[0.68,-0.97],I~2=0%,P=0.02),hospitaliz-ation mortality(OR,0.82[0.69,0.97],I~2=0%,P=0.02),length of stay in an ICU(MD,-1.94[-2.86,-1.02],I~2=40%,P<0.0001),Length of hospitalization(MD,-4.30[-7.75,-0.85,I~2=78%,P=0.01)and length of first mechanical ventilation(MD,-06-1.74,-0.39,I~2=0.002).In the adverse events of patients with sepsis and septic shock treated with low-dose glucocorticosteroids,significant differences were found between the experim-ental group and the control group in hyperglycemia(OR,1.74[1.40,2.16],I~2=0%,P<0.00001),hypernatremia(OR,1.69[1.15,2.49],I~2=9%,P=0.008)and myopathy(OR,1.29[1.03,1.63],I~2=0%,P=0.03).Secondary infection,site of infection,gastroduodenal bleeding,recurrent septic shock,poor wound healing,neurologic symptoms,and re-intubation were not significantly different between the two groups.In the 28-day mortality subgroup,treatment with intravenous hydrocortisone(200 mg/d)for 7 consecutive days in septic shock patients improved the patient’s mortality by 28 days.Conclusions:Routine treatment with low-dose glucocorticosteroids in sepsis and septic shock patients can improve the mortality of ICU,the duration of ICU,hospitalization and the duration of first mechanical ventilation,and significantly reduce the mortality of septic shock patients for 28 days,especially the effect of low-dose hydrocortisone(200mg/day)intravenous for7 consecutive days;however,it may increase the incidence of hyperglycemia,hypernatremia or muscle weakness in patients.