Steroid, ascorbic acid, and thiamine in adults with sepsis and septic shock: a systematic review and component network meta-analysis

AbstractTo assess the effect from individual component in combinations of steroid, ascorbic acid, and thiamine on outcomes in adults with sepsis and septic shock with component network meta-analysis (NMA). We searched PubMed, EMBASE, and the Cochrane Library Central Register of Controlled Trials from 1980 to March 2021 for randomized controlled trials (RCT) that studied the use of glucocorticoid, fludrocortisone, ascorbic acid, and thiamine in patients with sepsis and septic shock. Citations screening, study selection, data extraction, and risk of bias assessment were independently performed by two authors. The primary outcome was short-term mortality. Secondary outcomes were longer-term mortality, time to resolution of shock and duration of mechanical ventilation. Thirty-three RCTs including 9898 patients presented on short-term mortality. In additive component NMA, patients on ascorbic acid alone (RR 0.74, 95% CI 0.57–0.97) or the combination of glucocorticoid and fludrocortisone (RR 0.89, 95% CI 0.80–0.99) had lower short-term mortality, but only the latter was associated with improved long-term mortality (RR 0.89, 95% CI 0.82–0.98). The use of glucocorticoid or the combination of glucocorticoid, ascorbic acid and thiamine hastened resolution of shock. Component NMA showed glucocorticoid (MD − 0.96, 95% CI − 1.61 to − 0.30) but not ascorbic acid or thiamine shortened the time to resolution of shock. Glucocorticoid shortened the duration of mechanical ventilation (MD − 1.48, 95% CI − 2.43 to − 0.52). In adults with sepsis and septic shock, the combination of glucocorticoid and fludrocortisone improved short-term and longer-term mortality. Glucocorticoid shortened the time to resolution of shock and duration of mechanical ventilation. There was no strong evidence supporting the routine use of thiamine and ascorbic acid, but they were associated with minimal adverse effects.

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Effect of Premorbid Beta-Blockers on Mortality in Patients With Sepsis: A Systematic Review and Meta-Analysis

Journal of Intensive Care Medicine ◽

10.1177/08850666211052926 ◽

2021 ◽

pp. 088506662110529

Author(s):

Daisuke Hasegawa ◽

Ryota Sato ◽

Narut Prasitlumkum ◽

Kazuki Nishida

Keyword(s):

Systematic Review ◽

Beta Blockers ◽

Data Extraction ◽

Meta Analysis ◽

Controlled Trials ◽

Cochrane Central Register ◽

Short Term ◽

Cross Sectional ◽

Short Term Mortality ◽

The Impact

Objective The aim of this study was to conduct a systematic review and meta-analysis to investigate the impact of premorbid beta-blockers on mortality in patients with sepsis. Data Sources We searched EMBASE, the Cochrane Central Register of Controlled Trials, and MEDLINE for eligible studies. The protocol was registered at the PROSPERO (CRD42021256813). Study Selection Two authors independently evaluated the following inclusion criteria: (1) randomized controlled trials, cohort studies, cross-sectional studies; (2) patients with sepsis aged ≥18 years, and (3) premorbid beta-blocker use. Data Extraction Two authors extracted the patients’ characteristics and outcomes independently. All analyses were performed using the random-effects models. The primary outcome was short-term mortality, defined as mortality within 30 days, in-hospital or intensive care unit mortality. Data Synthesis Ten studies (n = 24 748 patients) were included. The pooled odds ratio (OR) of short-term mortality associated with the premorbid use of beta-blockers was 0.85 (95% confidence interval [CI], 0.69-1.04; P = .12; I2 = 50%). Five studies reported an adjusted OR of short-term mortality. The pooled adjusted OR of short-term mortality associated with the premorbid use of beta-blockers was 0.73 (95% CI, 0.65-0.83; P < .001; I2 = 0%). Conclusion Premorbid beta-blockers were associated with a lower short-term mortality in patients with sepsis.

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Hydrocortisone, ascorbic acid, and thiamine (HAT) for sepsis and septic shock: a meta-analysis with sequential trial analysis

Journal of Intensive Care ◽

10.1186/s40560-021-00589-x ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Weilan Na ◽

Huili Shen ◽

Yichu Li ◽

Dong Qu

Keyword(s):

Septic Shock ◽

Ascorbic Acid ◽

Sofa Score ◽

Meta Analysis ◽

Mean Difference ◽

Hospital Length Of Stay ◽

Controlled Trials ◽

Cochrane Central Register ◽

Significant Difference ◽

Sepsis And Septic Shock

Abstract Background Sepsis is a primary global health threat and costs a lot, requiring effective and affordable treatments. We performed this meta-analysis to explore the treatment of hydrocortisone, ascorbic acid, and thiamine (HAT) in sepsis and septic shock. Methods We searched Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception to August 14, 2021. We included randomized controlled trials (RCTs) that evaluated the HAT treatments in sepsis and septic shock. The primary outcome was the change in SOFA score over the 72 h. The second outcomes were the hospital, and 28-/30-day mortality, the duration of vasopressors, PCT clearance, hospital length of stay (LOS), and ICU LOS. We performed a subgroup analysis and a trial sequential analysis (TSA). The Der Simonian–Laird random-effects models were used to report the pooled risk ratios (RR) or mean difference (MD) with confidence intervals (CI). Results Nine RCTs, enrolling 1427 patients of sepsis and septic shock treated with HAT (717) or only standard care (710), were included. There was a significant difference between the two groups in the change in SOFA score over the first 72 h (MD 0.65, 95% CI 0.30 to 1.00), the duration of vasopressors (MD − 18.16, 95% CI − 25.65 to − 10.68) and the PCT clearance (MD 14.54, 95% CI 0.64 to 28.43). In addition, there was no significant difference in the hospital mortality (RR 1.07, 95% CI 0.85 to 1.34), the 28-/30-day mortality (RR 0.96, 95% CI 0.80 to 1.15), the hospital LOS (MD 0.78, 95% CI − 0.30 to 1.86), and ICU LOS (MD 0.12, 95% CI − 0.53 to 0.78). Conclusions The HAT combination improves the SOFA score in the first 72 h and reduces the duration of vasopressors in patients with sepsis. Given the minor mean difference of the change in SOFA score, the mortality benefit has not been observed. Trial registration PROSPERO, CRD42020203166.

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Thrombocytopenia in critically ill patients with sepsis or septic shock: a systematic review and meta-analysis

10.21203/rs.2.19094/v1 ◽

2019 ◽

Author(s):

Yuting Li ◽

Hongxiang Li ◽

Jianxing Guo ◽

Dong Zhang

Keyword(s):

Septic Shock ◽

Mechanical Ventilation ◽

Length Of Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Odds Ratio ◽

Meta Analysis ◽

Short Term ◽

Icu Length Of Stay ◽

Short Term Mortality

Abstract Background Thrombocytopenia is a common feature of sepsis or septic shock, but few meta-analyses have specifically evaluated prognostic importance of thrombocytopenia in patients with sepsis or septic shock. The objective of this meta-analysis was to evaluate the prognosis of thrombocytopenia in critically ill patients with sepsis or septic shock.Methods We searched the PubMed, Cochrane, and Embase databases for studies from inception to the 30th of November 2019. Prospective or retrospective cohort studies comparing thrombocytopenia to no thrombocytopenia in critically ill patients with sepsis or septic shock were included. All authors reported our primary outcome of short-term mortality(defined as ICU or 48-hour mortality) with clinically relevant secondary outcomes(ICU length of stay, rate of AKI, rate of mechanical ventilation). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI).Results Seven studies including 4243 patients were included. The results of this meta-analysis showed that the short-term mortality of thrombocytopenia group was higher than that of the no thrombocytopenia group (odds ratio [OR]=2.01;95% CI, 1.73-2.33; P<0.00001; I2=78%).In addition, compared with no thrombocytopenia group, thrombocytopenia group showed higher rate of AKI(odds ratio [OR]=1.31;95% CI, 1.03-1.66; P=0.03 I2=65%) and longer ICU length of stay(Mean difference=1.31;95% CI, 0.66-1.96; P<0.0001; I2=50%). There was no statistically significant difference in the rate of mechanical ventilation between 2 groups (odds ratio [OR]=1.24;95% CI, 0.82-1.88; P=0.30; I2=0%).Conclusions Thrombocytopenia was associated with increased short-term mortality, ICU length of stay and rate of AKI in critically ill patients with sepsis or septic shock. The analysis of secondary outcomes showed no significant difference in the rate of mechanical ventilation between the two groups. Further randomized controlled studies of thrombocytopenia are still required.

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Exercise therapy improves eGFR, and reduces blood pressure and BMI in non-dialysis CKD patients: evidence from a meta-analysis

BMC Nephrology ◽

10.1186/s12882-019-1586-5 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 9

Author(s):

Lijun Zhang ◽

Yangyang Wang ◽

Lianlian Xiong ◽

Yanfang Luo ◽

Zhijun Huang ◽

...

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Exercise Therapy ◽

Cardiovascular Health ◽

Data Extraction ◽

Meta Analysis ◽

Density Lipoprotein ◽

Cochrane Library ◽

Healthy Population ◽

Short Term

Abstract Background Patients with chronic kidney disease (CKD) have a high prevalence of cardiovascular diseases, which often lead to physical inactivity that correlates with CKD exacerbation. The benefits of regular exercise to cardiovascular health have been well established in healthy population and highly suggestive in patients with CKD. To further strengthen the evidence base for the management of CKD, this meta-analysis was performed to systematically evaluate the effects of exercise therapy on renal function, blood pressure, blood lipid and body mass index (BMI) in non-dialysis CKD patients. Methods This meta-analysis was conducted following a previous protocol. Randomized controlled trials (RCTs) examining the effects of exercise therapy in non-dialysis CKD patients were searched in Pubmed, Embase, Cochrane Library, and three major Chinese biomedical databases (CNKI, WANGFANG and VIP) from their start date to October 30th, 2018. The Cochrane systematic review methods were applied for quality assessment and data extraction, and Revman version 5.3 was used for systematic review and meta-analysis. Results 13 RCTs, representing 421 patients with non-dialysis CKD, were included in this meta-analysis. Compared to the controls, exercise therapy brought an increase in eGFR (MD = 2.62, 95% CI:0.42 to 4.82, P = 0.02, I2 = 22%), and decreases in systolic blood pressure (SBP) (MD = -5.61, 95% CI:-8.99 to − 2.23, P = 0.001, I2 = 44%), diastolic blood pressure (DBP) (MD = -2.87, 95% CI:-3.65 to − 2.08, P < 0.00001, I2 = 16%) and BMI (MD = -1.32, 95% CI:-2.39 to − 0.25, P = 0.02, I2 = 0%) in non-dialysis CKD patients. Exercise therapy of short-term (< 3 months) decreased triglyceride (TG) level (P = 0.0006). However, exercise therapy did not significantly affect serum creatinine (SCr), total cholesterol (TC), high density lipoprotein (HDL) or low density lipoprotein (LDL) in non-dialysis CKD patients. Conclusion Exercise therapy could benefit non-dialysis CKD patients by increasing eGFR while reducing SBP, DBP and BMI. Additionally, short-term intervention of exercise could decrease TG.

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Optimal duration of prone positioning in patients with acute respiratory distress syndrome: a protocol for a systematic review and meta-regression analysis

BMJ Open ◽

10.1136/bmjopen-2017-021408 ◽

2018 ◽

Vol 8 (9) ◽

pp. e021408 ◽

Cited By ~ 3

Author(s):

Tetsuro Kamo ◽

Yoshitaka Aoki ◽

Tatsuma Fukuda ◽

Kiyoyasu Kurahashi ◽

Hideto Yasuda ◽

...

Keyword(s):

Systematic Review ◽

Distress Syndrome ◽

Meta Analysis ◽

Controlled Trials ◽

Prone Positioning ◽

Short Term ◽

Optimal Duration ◽

Short Term Mortality ◽

Meta Regression ◽

Meta Regression Analysis

IntroductionSeveral systematic reviews and meta-analyses have demonstrated that prolonged (≥16 hours) prone positioning can reduce the mortality associated with acute respiratory distress syndrome (ARDS). However, the effectiveness and optimal duration of prone positioning was not fully evaluated. To fill these gaps, we will first investigate the effectiveness of prone positioning compared with the conventional management of patients with ARDS, regarding outcomes using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Second, if statistical heterogeneity in effectiveness with regard to short-term mortality (intensive care unit death or ≤30-day mortality) is shown, we will conduct a meta-regression analysis to explore the association between duration and effectiveness, and determine the optimal duration of prone positioning.Method and analysisRelevant studies are collected using PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials and the WHO International Clinical Trials Platform Search Portal. Randomised controlled trials comparing prone and supine positioning in adults with ARDS will be included in the meta-analysis. Two independent investigators will screen trials obtained by search eligibility and extract data from selected studies to standardised data recording forms. For each selected trial, the risk of bias and quality of evidence will be evaluated using the GRADE system. Meta-regression analyses will be performed to identify the most important factors associated with short-term mortality, and subgroup analysis will be used to analyse the following: duration of mechanical ventilation in the prone position per day, patient severity, tidal volume and cause of ARDS. If heterogeneity or inconsistency among the studies is detected, subgroup analysis will be conducted on factors that may cause heterogeneity.Ethics and disseminationThis study requires no ethical approval. The results obtained from this systematic review and meta-analysis will be disseminated through international conference presentations and publication in a peer-reviewed journal.PROSPERO registration numberCRD42017078340.

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Preoxygenation before intubation in adult patients with acute hypoxemic respiratory failure: a network meta-analysis of randomized trials

Critical Care ◽

10.1186/s13054-019-2596-1 ◽

2019 ◽

Vol 23 (1) ◽

Cited By ~ 6

Author(s):

Ka Man Fong ◽

Shek Yin Au ◽

George Wing Yiu Ng

Keyword(s):

Respiratory Failure ◽

Data Extraction ◽

Meta Analysis ◽

Adult Patients ◽

Cochrane Library ◽

Controlled Trials ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure ◽

Study Selection ◽

Screening Study

Abstract Background Patients with acute hypoxemic respiratory failure are at risk for life-threatening complications during endotracheal intubation. Preoxygenation might help reduce the risk of hypoxemia and intubation-related complications. This network meta-analysis summarizes the efficacy and safety of preoxygenation methods in adult patients with acute hypoxemic respiratory failure. Methods We searched PubMed, EMBASE, and the Cochrane Library Central Register of Controlled Trials through April 2019 for randomized controlled trials (RCT) that studied the use of conventional oxygen therapy (COT), high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), and HFNC and NIV as preoxygenation before intubation in patients with acute hypoxemic respiratory failure. Citations’ screening, study selection, data extraction, and risk of bias assessment were independently performed by two authors. The primary outcome was the lowest SpO2 during the intubation procedure. Results We included 7 RCTs (959 patients). Patients preoxygenated with NIV had significantly less desaturation than patients treated with COT (mean difference, MD 5.53, 95% CI 2.71, 8.34) and HFNC (MD 3.58, 95% CI 0.59, 6.57). Both NIV (odds ratio, OR 0.43, 95% CI 0.21, 0.87) and HFNC (OR 0.49, 95% CI 0.28, 0.88) resulted in a lower risk of intubation-related complications than COT. There were no significant mortality differences among the use of NIV, HFNC, COT, and HFNC and NIV during preoxygenation. Conclusions In adult patients with acute hypoxemic respiratory failure, NIV is a safe and probably the most effective preoxygenation method.

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Effect of Therapeutic Exercise on Pain and Disability in the Management of Chronic Nonspecific Neck Pain: Systematic Review and Meta-Analysis of Randomized Trials

Physical Therapy ◽

10.2522/ptj.20120412 ◽

2013 ◽

Vol 93 (8) ◽

pp. 1026-1036 ◽

Cited By ~ 74

Author(s):

Lucia Bertozzi ◽

Ivan Gardenghi ◽

Francesca Turoni ◽

Jorge Hugo Villafañe ◽

Francesco Capra ◽

...

Keyword(s):

Neck Pain ◽

Randomized Trials ◽

Data Extraction ◽

Meta Analysis ◽

Relevant Literature ◽

Controlled Trials ◽

Cochrane Central Register ◽

Therapeutic Exercise ◽

Short Term ◽

Evidence Database

BackgroundGiven the prevalence of chronic nonspecific neck pain (CNSNP) internationally, attention has increasingly been paid in recent years to evaluating the efficacy of therapeutic exercise (TE) in the management of this condition.PurposeThe purpose of this study was to conduct a current review of randomized controlled trials concerning the effect of TE on pain and disability among people with CNSNP, perform a meta-analysis, and summarize current understanding.Data SourcesData were obtained from MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Physiotherapy Evidence Database (PEDro), and Cochrane Central Register of Controlled Trials (CENTRAL) databases from their inception to August 2012. Reference lists of relevant literature reviews also were tracked.Study SelectionAll published randomized trials without any restriction regarding time of publication or language were considered for inclusion. Study participants had to be symptomatic adults with only CNSNP.Data ExtractionTwo reviewers independently selected the studies, conducted the quality assessment, and extracted the results. Data were pooled in a meta-analysis using a random-effects model.Data SynthesisSeven studies met the inclusion criteria. Therapeutic exercise proved to have medium and significant short-term and intermediate-term effects on pain (g=−0.53, 95% confidence interval [CI]=−0.86 to −0.20, and g=−0.45, 95% CI=−0.82 to −0.07, respectively) and medium but not significant short-term and intermediate-term effects on disability (g=−0.39, 95% CI=−0.86 to 0.07, and g=−0.46, 95% CI=−1.00 to −0.08, respectively).LimitationsOnly one study investigated the effect of TE on pain and disability at follow-up longer than 6 months after intervention.ConclusionsConsistent with other reviews, the results support the use of TE in the management of CNSNP. In particular, a significant overall effect size was found supporting TE for its effect on pain in both the short and intermediate terms.

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Comparison of the effects of mini-implant and traditional anchorage on patients with maxillary dentoalveolar protrusion

The Angle Orthodontist ◽

10.2319/051016-375.1 ◽

2016 ◽

Vol 87 (2) ◽

pp. 320-327 ◽

Cited By ~ 9

Author(s):

Yanhua Xu ◽

Jiye Xie

Keyword(s):

Treatment Effects ◽

Data Extraction ◽

Meta Analysis ◽

Cochrane Library ◽

Maxillary Incisor ◽

Controlled Trials ◽

Mini Implants ◽

Anterior Teeth ◽

Maxillary Molar ◽

Soft Tissue Changes

ABSTRACT Objective: To compare the treatment effects of mini-implants as anchor units with conventional methods of anchorage reinforcement in maxillary dentoalveolar protrusion patients in terms of skeletal, dental, and soft tissue changes. Materials and Methods: We searched the databases of the Cochrane Library, PubMed, OVIDSP, CBM, VIP, WanFang Data, and CNKI covering December 1966 to March 2016 for randomized controlled trials (RCTs) and clinical controlled trials that compared the treatment effects of mini-implants with conventional anchorage reinforcement in maxillary dentoalveolar protrusion patients. Literature filtering, data extraction, and methodological quality evaluation were finished independently by two researchers and disagreements were solved by discussion. Meta-analysis was performed when possible; otherwise descriptive assessment was done. Results: Through a predefined search strategy, we finally included 14 eligible studies. Eight outcomes were evaluated in this study: maxillary incisor retraction, maxillary molar movement, U1-SN, SNA, SN-MP, UL-E Plane, NLA and G-Sn-Pg. Conclusions: Mini-implant anchorage was more effective in retracting the anterior teeth, produced less anchorage loss, and had a greater effect on SN-MP for the high-angle patients than did traditional anchorage. Both mini-implants and traditional anchorage underwent decreases in on U1-SN and SNA. More qualified RCTs are required to make reliable recommendations about the anchorage capacity of mini-implant and traditional anchorage in patients with maxillary dentoalveolar protrusion, especially on the UL-E plane, NLA, and G-Sn-Pg.

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Corticosteroid use in COVID-19 patients: A systematic review and meta-analysis on clinical outcomes

10.21203/rs.3.rs-52240/v2 ◽

2020 ◽

Author(s):

Judith van Paassen ◽

Jeroen S. Vos ◽

Eva M. Hoekstra ◽

Katinka M.I. Neumann ◽

Pauline C. Boot ◽

...

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Observational Studies ◽

Oxygen Therapy ◽

Meta Analysis ◽

Viral Clearance ◽

Care Group ◽

Short Term ◽

Secondary Infections ◽

Short Term Mortality

Abstract Background: In the current SARS-CoV-2 pandemic, there has been worldwide debate on the use of corticosteroids in COVID-19. In the recent RECOVERY trial, evaluating the effect of dexamethasone, a reduced 28-day mortality in patients requiring oxygen therapy or mechanical ventilation was shown. Their results have led to considering amendments in guidelines or actually already recommending corticosteroids in COVID-19. However, the effectiveness and safety of corticosteroids still remain uncertain, and reliable data to further shed light on the benefit and harm are needed. Objectives: The aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of corticosteroids in COVID-19. Methods: A systematic literature search of RCTS and observational studies on adult patients was performed across Medline/PubMed, Embase, and Web of Science from 1st of December 2019 until 1 st of October 2020, according to the PRISMA guidelines. Primary outcomes were short-term mortality and viral clearance (based on RT-PCR in respiratory specimens). Secondary outcomes were: need for mechanical ventilation, other oxygen therapy, length of hospital stay and secondary infections. Results: Forty-four studies were included, covering 20.197 patients. In twenty-two studies, the effect of corticosteroid use on mortality was quantified. The overall pooled estimate (observational studies and RCTs) showed a significant reduced mortality in the corticosteroid group (OR 0.72 (95%CI 0.57-0.87). Furthermore, viral clearance time ranged from 10-29 days in the corticosteroid group and from 8-24 days in the standard of care group. Fourteen studies reported a positive effect of corticosteroids on need for and duration of mechanical ventilation. A trend towards more infections and antibiotic use was present. Conclusions: Our findings from both observational studies and RCTs confirm a beneficial effect of corticosteroids on short-term mortality and a reduction of need for mechanical ventilation. And although data in the studies were too sparse to draw any firm conclusions, there might be a signal of delayed viral clearance and an increase in secondary infections.

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The Effect of Early Vasopressin Use on Patients With Septic Shock: A Systematic Review and Meta-analysis

10.21203/rs.3.rs-99744/v1 ◽

2020 ◽

Author(s):

Haijun Huang ◽

Chenxia Wu ◽

Qinkang Shen ◽

Hua Xu ◽

Yixin Fang ◽

...

Keyword(s):

Septic Shock ◽

Length Of Stay ◽

Meta Analysis ◽

Mean Difference ◽

Short Term ◽

Vasopressin Infusion ◽

Icu Length Of Stay ◽

Short Term Mortality ◽

Length Of Hospitalization ◽

New Onset

Abstract Background: The effect of early vasopressin initiation on clinical outcomes in patients with septic shock is uncertain. A systematic review and meta-analysis was performed to evaluate the impact of early start of vasopressin support within 6 hours after the diagnosis on clinical outcomes in septic shock patients.Methods: We searched the PubMed, Cochrane, and Embase databases for randomized controlled trials (RCTs) and cohort studies from inception to the 1st of October 2020. We included studies involving adult patients (> 16 years)with septic shock. All authors reported our primary outcome of short-term mortality and in the experimental group patients in the studies receiving vasopressin infusion within 6 hours after diagnosis of septic shock and in the control group patients in the studies receiving no vasopressin infusion or vasopressin infusion 6 hours after diagnosis of septic shock, clearly comparing with clinically relevant secondary outcomes(use of renal replacement therapy(RRT),new onset arrhythmias, ICU length of stay and length of hospitalization). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI).Results: Five studies including 788 patients were included. The primary outcome of this meta-analysis showed that short-term mortality between the two groups was no difference (odds ratio [OR] = 1.09; 95% CI, 0.8 to 1.48; P =0.6; χ2 =0.83; I2 = 0%). Secondary outcomes demonstrated that the use of RRT was less in the experimental group than that of the control group (OR =0.63; 95% CI, 0.44 to 0.88; P =0.007; χ2 =3.15; I2 =36%).The new onset arrhythmias between the two groups was no statistically significant difference (OR =0.59; 95% CI, 0.31 to 1.1; P =0.10; χ2 =4.7; I2 =36%). There was no statistically significant difference in the ICU length of stay(mean difference = 0.16; 95% CI, - 0.91 to 1.22; P = 0.77; χ2 = 6.08; I2 =34%) and length of hospitalization (mean difference = -2.41; 95% CI, -6.61 to 1.78; P = 0.26; χ2 = 8.57; I2 =53%) between the two groups.Conclusions: Early initiation of vasopressin in patients within 6 hours of septic shock onset was not associated with decreased short-term mortality, new onset arrhythmias, shorter ICU length of stay and length of hospitalization, but can reduce the use of RRT. Further large-scale RCTs are still needed to evaluate the benefit of starting vasopressin in the early phase of septic shock.

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