Efficacy and safety of corticosteroids in immunocompetent patients with septic shock

Xin Lu, Wei Han, Yan-xia Gao, Shi-gong Guo, Shi-yuan Yu, Xue-zhong Yu, Hua-dong Zhu, Yi Li

Table 1 Characteristics of included RCTs comparing corticosteroids versus control in immunocompetent patients with septic shock

Study Design and study place Sample size (corticosteroids /control) Excluded population (major selection criteria) Intervention Outcomesa Annane et al[29] (2002) Multicenter (19 sites), France 150/149 Advanced form of cancer or AIDS infection IV hydrocortisone 50 mg bolus q6h and po fludrocortisone 50 μg qd versus placebo for seven days ICU mortality, 28-day mortality, hospital mortality, one-year mortality, seven-day mortality,b shock reversal, and safety outcomes Briegel et al[30] (1999) One center, Germany 20/20 End-stage neoplasm, organ transplant recipients IV hydrocortisone 100 mg loading, followed by 0.18 mg/(kg·h) continuous infusion until shock reversal, then reduced to 0.08 mg/(kg·h) for six days, then tapered off versus placebo (physiologic saline solution) Shock reversal, 28-day mortality,b ICU mortality, hospital mortality, one-year mortality, seven-day mortality,b and safety outcomes Cicarelli et al[27] (2007) One center, Brazil 14/15 Immunosuppression therapy, end stage neoplasm with a life expectancy of less than three months IV dexamethasone 0.2 mg/kg q36h for three doses versus placebo (0.9% physiological saline solution) Seven-day mortality, 28-day mortality, and shock reversal Doluee et al[32] (2018) One center, Iran 56/52 Malignancy IV hydrocortisone 50 mg q6h versus placebo (saline in the same volume) for seven days Twenty-eight-day mortality Luce et al[31] (1988) One center, USA 38/37 Severe immunodeficiency and AIDS IV methylprednisolone 30 mg/kg q6h for four doses versus mannitol placebo Incidence of ARDS, hospital mortality, and safety outcomes Lv et al[24] (2017) One center, China 58/60 Immunosuppression IV hydrocortisone 200 mg/d for six days, then tapered off versus placebo (normal saline) Hospital mortality, 28-day mortality, shock reversal, and length of stay in ICU and hospital Oppert et al[28] (2005) One center, Germany 18/23 HIV positive or recipients of organ transplants IV hydrocortisone 50 mg bolus, followed by 0.18 mg/(kg·h) continuous infusion until shock reversal, then tapered off versus placebo Time to cessation of vasopressor support, 28-day mortality, and shock reversal Sprung et al[26] (2008) Multicenter (52 sites), Europe and Israel 251/248 Immunosuppression IV hydrocortisone 50 mg q6h for five days, then tapered to 50 mg q12h for three days, then 50 mg QD for three days versus placebo Mortality in ICU and hospital, 28-day mortality, one-year mortality, shock reversal, length of stay in ICU and hospital, and safety outcomes Wan et al[25] (2014) One center, China 62/27 Advanced form of cancer or HIV infection IV hydrocortisone 50 mg q6h for seven days or five days versus saline Shock reversal, 28-day mortality, seven-day mortality, length of stay in ICU, and safety outcomes