Low-Dose Steroids Cut Mortality in Septic Shock

2006 ◽  
Vol 36 (19) ◽  
pp. 24
Author(s):  
BRUCE JANCIN
Keyword(s):  
Septic Shock ◽  
Low Dose

Low-Dose Hydrocortisone Therapy Attenuates Septic Shock in Adult Patients But Does Not Reduce 28-Day Mortality

2014 ◽  
Vol 58 (5) ◽  
pp. 213-214
Author(s):  
Changsong Wang ◽  
Jiaxiao Sun ◽  
Juanjuan Zheng ◽  
Lei Guo ◽  
Hongyan Ma ◽  
...  
Keyword(s):  
Septic Shock ◽  
Low Dose ◽  
Adult Patients

Low-dose corticosteroids for adult patients with septic shock: a systematic review with meta-analysis and trial sequential analysis

2018 ◽  
Vol 44 (7) ◽  
pp. 1003-1016 ◽  
Author(s):  
Sofie Louise Rygård ◽  
Ethan Butler ◽  
Anders Granholm ◽  
Morten Hylander Møller ◽  
Jeremy Cohen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Sequential Analysis ◽  
Low Dose ◽  
Meta Analysis ◽  
Adult Patients ◽  
Trial Sequential Analysis

Hydrocortisone Therapy for Patients with Septic Shock

2018 ◽  
pp. 301-306
Author(s):  
Ryan J. Horvath ◽  
Edward Bittner
Keyword(s):  
Septic Shock ◽  
Study Design ◽  
Steroid Therapy ◽  
Clinical Case ◽  
Low Dose ◽  
Vasopressor Therapy ◽  
Surviving Sepsis Campaign ◽  
Number Of Patients ◽  
Study Intervention

This chapter provides a summary of the landmark study known as the CORTICUS trial. Among patients suffering from septic shock, does low dose hydrocortisone improve mortality? Starting with that question, it describes the basics of the study, including funding, study location, the population studies, number of patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. The CORTICUS trial failed to demonstrate a benefit on mortality with steroid therapy among patients with septic shock. Based on CORTICUS and other studies, the Surviving Sepsis Campaign guidelines no longer recommend steroids for all patients with septic shock. Corticosteroids should be considered, however, for patients with septic shock who do not respond to fluids and vasopressor therapy.

scholarly journals Effect of Very Low-Dose Hydrocortisone on Shock Reversal in Patients With Septic Shock

2020 ◽  
Vol 2 (4) ◽  
pp. e0096
Author(s):  
Robert Sbertoli ◽  
Zeyu Hu ◽  
Jonathan Henke ◽  
Eric Wu ◽  
Shrihari Santosh ◽  
...  
Keyword(s):  
Septic Shock ◽  
Low Dose ◽  
Shock Reversal

scholarly journals Do low-dose corticosteroids improve survival or shock reversal from septic shock in adults? Meta-analysis with trial sequential analysis

2018 ◽  
Vol 46 (7) ◽  
pp. 2513-2524 ◽  
Author(s):  
Rui Xu ◽  
Qian Wang ◽  
Yan Huang ◽  
Ling Wu ◽  
Qi Liu ◽  
...  
Keyword(s):  
Septic Shock ◽  
Relative Risk ◽  
Confidence Interval ◽  
Sequential Analysis ◽  
Low Dose ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Trial Sequential Analysis ◽  
Control Group ◽  
Shock Reversal

Objective This meta-analysis with trial sequential analysis (TSA) was performed to determine whether low-dose corticosteroids (LDCs) can improve survival or shock reversal from septic shock in adults. Methods A literature search was performed using several databases (Medline, Cochrane Library, Embase, and Chinese Biological Medical Database) until 23 October 2017. The systematic review was registered in PROSPERO. Results Nine randomized controlled trials (RCTs) (n = 1182) were included. LDC intervention improved 7-day shock reversal compared with the control group (relative risk, 1.36; TSA-adjusted 95% confidence interval, 1.20–1.54). LDCs had no statistically significant effects on gastrointestinal bleeding or superinfection. LDCs did not reduce 28-day mortality from septic shock (relative risk, 0.96; TSA-adjusted 95% confidence interval, 0.74–1.24). The TSA indicated that RCTs of about 3000 patients would be needed to draw definitive conclusions; similar results were obtained in a subgroup analysis of nonresponders. Conclusions LDCs improve 7-day shock reversal. However, whether LDCs improve 28-day survival from septic shock in adults remains unclear. The results of well-designed larger RCTs are needed.

scholarly journals Effects of low-dose hydrocortisone and hydrocortisone plus fludrocortisone in adults with septic shock: a protocol for a systematic review and meta-analysis of individual participant data

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040931
Author(s):  
Djillali Annane ◽  
Romain Pirracchio ◽  
Laurent Billot ◽  
Andre Waschka ◽  
Sylvie Chevret ◽  
...  
Keyword(s):  
Septic Shock ◽  
Usual Care ◽  
Latin American ◽  
Low Dose ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Primary Analysis ◽  
Mixed Effect ◽  
Meta Analyses

IntroductionThe benefits and risks of low-dose hydrocortisone in patients with septic shock have been investigated in numerous randomised controlled trials and trial-level meta-analyses. Yet, the routine use of this treatment remains controversial. To overcome the limitations of previous meta-analyses inherent to the use of aggregate data, we will perform an individual patient data meta-analysis (IPDMA) on the effect of hydrocortisone with or without fludrocortisone compared with placebo or usual care on 90-day mortality and other outcomes in patients with septic shock.Methods and analysisTo assess the benefits and risks of hydrocortisone, with or without fludrocortisone for adults with septic shock, we will search major electronic databases from inception to September 2020 (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and Latin American Caribbean Health Sciences Literature), complimented by a search for unpublished trials. The primary analysis will compare hydrocortisone with or without fludrocortisone to placebo or no treatment in adult patients with septic shock. Secondary analyses will compare hydrocortisone to placebo (or usual care), hydrocortisone plus fludrocortisone to placebo (or usual care), and hydrocortisone versus hydrocortisone plus fludrocortisone. The primary outcome will be all cause mortality at 90 days. We will conduct both one-stage IPDMA using mixed-effect models and machine learning with targeted maximum likelihood analyses. We will assess the risk of bias related to unshared data and related to the quality of individual trial.Ethics and disseminationThis IPDMA will use existing data from completed randomised clinical trials and will comply with the ethical and regulatory requirements regarding data sharing for each of the component trials. The findings of this study will be submitted for publication in a peer-review journal with straightforward policy for open access.PROSPERO registration numberCRD42017062198.

Adrenal status in children with septic shock using low-dose stimulation test*

2006 ◽  
Vol PAP ◽  
Author(s):  
Manjunatha Sarthi ◽  
Rakesh Lodha ◽  
Subbiah Vivekanandhan ◽  
Narendra K. Arora
Keyword(s):  
Septic Shock ◽  
Low Dose ◽  
Stimulation Test
Sign in / Sign up

Export Citation Format

Share Document