A Meta-analysis Of Clinical Evaluation Of Early Goal-directed Therapy For Treatment Of Severe Sepsis

Objective To evalute and analysis the clinical curative effect of Early Goal-Directed Therapy for treatment of Severe Sepsis.Meathods Using Cochrane systematic review of methods for data Meta-analysis. Search electronic database on the computer, collect relevant literature researchs. Then formulate detailed inclusion and exclusion criteria, analysis the data of the RCT and prospective studies which was included, and extract relevant data, analysis and conclusions of the reports. The outcome indicators for assessing the effectiveness have include: 28 days mortality, 60 days mortality, 90 days mortality, ICU Staying Time and Ventilation time. The details are as follows.1. “early goal-directed therapy”, “sepsis”, “severe sepsis” and “septic shock” as key words,we search the Pubmed, Nature, Science, CNKI, WANFANG, VIP, Sino Med and collected the prospective studies and randomized, controlled and clinical trials about the treatment of severe sepsis and septic shock by EGDT published in 2001~2015. The researchs which included require the test group treated with EGDT and the control group treated with usual care.2. By reading the literature titles, eliminate the irrelevant literatures, repetitive literatures, animal testing and some other documents, and further by reading literature contents, eliminate retrospective analysis, similar to literatures published by the same population, ultimately through in strict accordance with the inclusion criteria 11 articles were included in the study and data analysis.3. Using the Cochrane collaboration’s Review Manager 5.1.1 software for Meta analysis. Count data using odds ratio and 95% confidence interval as effector evaluation; continuous variable data using mean difference or standandardized mean difference and 95% confidence interval as effector evaluation. If P<0.05, it said the difference was statistically sifnificant. Pay attention to heterogeneity between studies,if heterogeneity within an acceptable range, using the fixed model for Meta analysis;if heterogeneity is large, using random effects model for Meta analysis. Detect the publication bias of the research and draw funnel plots, at the same time, using stata12.0 software by Begg’s method and Egger’s method to detect the publication bias of the research.Results A total of 11 studies were included, of which 4 were overseas studies, 7 for domestic research. A total of 4687 cases were included, of which 2336 cases were treated by early goal-directed therapy, 2351 cases were treated by usual care. The specific results are as follows.1. 28 days mortality A total of 6 studies reported 28 days mortality, including 3 overseas studies and 3domestic studies, a total of 3483 cases. The results show that: Compared with the conventional treatment group, the usual care may reduce the number of deaths by 28 days, the difference was statistically significant, [OR=0.69,95%CI(0.49,0.97),P=0.03]。2. 60 days mortality A total of 3 studies reported 60 days mortality, all of them are overseas studies, a total of 2704 cases. The results show that: Compared with the conventional treatment group, the early goal-directed therapy may reduce the number of deaths by 60 days,the difference was statistically significant, [OR=0.66,95%CI(0.44,0.97),P=0.04]。3. 90 days mortality A total of 3 studies reported 90 days mortality, all of them are overseas studies, a total of 3648 cases. The results show that: no statistically significant difference was found between 90 days mortality of early goal-directed therapy grooup and conventional treatment group, [OR=0.98,95%CI(0.84,1.14),P=0.76]。4. ICU Staying Time A total of 6 studies reported ICU Staying Time, including 1 overseas studies and5 domestic studies, a total of 1498 cases. The results show that: Compared with the conventional treatment group, the early goal-directed therapy can shorten the ICU staying time of server sepsis patients, the difference was statistically significant,[SMD=-3.21,95%CI(-4.35,-2.08),P<0.00001]。5. Ventilation time A total of 5 studies reported Ventilation time, including 2 overseas studies and 3domestic studies, a total of 2583 cases. The results show that: Compared with the conventional treatment group, the early goal-directed therapy can shorten the Ventilation time of server sepsis patients, the difference was statistically significant,[SMD=-0.98,95%CI(-1.28,-0.68),P<0.00001]。Conclusion EGDT is superior to usual care in reducing 28 days mortality, 60 days mortality, ICU Staying Time and Ventilation time of severe sepsis and septic shock, but EGDT doesn’t reduce 90 days mortality of severe sepsis and septic shock.