| Title |
Glucocorticosteroids for sepsis: systematic review with meta-analysis and trial sequential analysis
|
|---|---|
| Published in |
Intensive Care Medicine, June 2015
|
| DOI | 10.1007/s00134-015-3899-6 |
| Pubmed ID | |
| Authors |
M. Volbeda, J. Wetterslev, C. Gluud, J. G. Zijlstra, I. C. C. van der Horst, F. Keus |
| Abstract |
Glucocorticosteroids (steroids) are widely used for sepsis patients. However, the potential benefits and harms of both high and low dose steroids remain unclear. A systematic review of randomised clinical trials with meta-analysis and trial sequential analysis (TSA) might shed light on this clinically important question. A systematic review was conducted according to a published protocol and The Cochrane Handbook methodology including meta-analyses, TSA of randomised clinical trials, and external validity estimation (GRADE). Randomised clinical trials evaluating steroids were included for sepsis patients (systemic inflammatory response syndrome, sepsis, severe sepsis or septic shock) aged >18 years. Cochrane Central Register of Controlled Trials (CENTRAL), PubMed/Medline, Embase, Web of Science and Cinahl were searched until 18 February 2015. No language restrictions were applied. Primary outcomes were mortality at longest follow-up and serious adverse events. A total of 35 trials randomising 4682 patients were assessed and reviewed in full text. All trials but two had high risk of bias. No statistically significant effect was found for any dose of steroids versus placebo or no intervention on mortality at maximal follow-up [relative risk (RR) 0.89; TSA adjusted confidence interval (CI) 0.74-1.08]. Two trials with low risk of bias also showed no statistically significant difference (random-effects model RR 0.38, 95 % CI 0.06-2.42). Similar results were obtained in subgroups of trials stratified according to high (>500 mg) or low (≤500 mg) dose hydrocortisone (or equivalent) (RR 0.87; TSA-adjusted CI 0.38-1.99; and RR 0.90; TSA-adjusted CI 0.49-1.67, respectively). There were also no statistically significant effects on serious adverse events other than mortality (RR 1.02; TSA-adjusted CI 0.7-1.48). The effects did not vary according to the degree of sepsis. TSA showed that many more randomised patients are needed before definitive conclusions may be drawn. Evidence to support or negate the use of steroids in any dose in sepsis patients is lacking. The results of ongoing and future well-designed, large randomised clinical trials are needed. |
X Demographics
The data shown below were collected from the profiles of 5 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Mexico | 1 | 20% |
| Saudi Arabia | 1 | 20% |
| Unknown | 3 | 60% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 4 | 80% |
| Practitioners (doctors, other healthcare professionals) | 1 | 20% |
Mendeley readers
The data shown below were compiled from readership statistics for 170 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Norway | 1 | <1% |
| Belgium | 1 | <1% |
| Denmark | 1 | <1% |
| Japan | 1 | <1% |
| United States | 1 | <1% |
| Unknown | 165 | 97% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 22 | 13% |
| Other | 21 | 12% |
| Student > Ph. D. Student | 21 | 12% |
| Student > Postgraduate | 17 | 10% |
| Student > Master | 17 | 10% |
| Other | 42 | 25% |
| Unknown | 30 | 18% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 92 | 54% |
| Pharmacology, Toxicology and Pharmaceutical Science | 12 | 7% |
| Agricultural and Biological Sciences | 6 | 4% |
| Biochemistry, Genetics and Molecular Biology | 5 | 3% |
| Immunology and Microbiology | 4 | 2% |
| Other | 15 | 9% |
| Unknown | 36 | 21% |
Attention Score in Context
This research output has an Altmetric Attention Score of 10. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 13 September 2021.
All research outputs
#3,476,082
of 24,761,242 outputs
Outputs from Intensive Care Medicine
#2,104
of 5,302 outputs
Outputs of similar age
#43,008
of 269,256 outputs
Outputs of similar age from Intensive Care Medicine
#8
of 86 outputs
Altmetric has tracked 24,761,242 research outputs across all sources so far. Compared to these this one has done well and is in the 85th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 5,302 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 29.4. This one has gotten more attention than average, scoring higher than 60% of its peers.
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We're also able to compare this research output to 86 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 91% of its contemporaries.