Methods for Anterior Torque Control during Retraction: A Systematic Review

Abstract BackgroundThere are various methods to control the inclination of the incisors during retraction, but there is no evidence as to the advantages of some methods over others. The purpose of this systematic review and meta-analysis was to determine the effectiveness of the methods used to control torque during anterior teeth retraction.MethodsIn accordance with the PRISMA guidelines, the main research question was defined in the PICO format [P: patients with complete permanent dentition; I: the maxillary incisor torque after (I) and before (C) retraction with straight-wire appliance and different modes of torque control; O: statistically significant differences in torque values of the upper incisors after orthodontic treatment]. The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched for keywords combining: retraction orthodontics, torque control orthodontics, torque orthodontics, inclination orthodontics, torque control retraction. The articles were subjected to risk of bias and quality analyses with the ROBINS-I protocol and the modified Newcastle–Ottawa QAS, respectively. Meta-analyses were performed with both fixed and random effects models.Results13 articles were selected in which total number of 580 subjects took part. In all studies incisors were retroclined during retraction by 2.46° (mean difference), which was statistically significant. Considering articles separately, differences in torque between the study group and the control group were statistically significant in 6 articles. The Q statistic value was 36.25 with p = .0003 and I2 = 66.9% which indicate a high level of study heterogeneity.ConclusionBoth properly performed corticotomy and en-masse retraction using orthodontic microimplants seem to be the most effective and scientifically validated methods of torque control. Further high-quality research is needed to perform better quality analyses and draw more reliable conclusions.

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Tolerability of statin-based management of patients with a history of statin-associated muscle symptoms: protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2021-052341 ◽

2021 ◽

Vol 11 (8) ◽

pp. e052341

Author(s):

Fanny Villoz ◽

Christina Lyko ◽

Cinzia Del Giovane ◽

Nicolas Rodondi ◽

Manuel R Blum

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Mean Difference ◽

Control Group ◽

Cochrane Central Register ◽

Eligibility Criteria ◽

Clinical Issue ◽

Standard Data ◽

Evaluation Approach ◽

History Of

IntroductionStatin-associated muscle symptoms (SAMSs) are a major clinical issue in the primary and secondary prevention of cardiovascular events. Current guidelines advise various approaches mainly based on expert opinion. We will lead a systematic review and meta-analysis to explore the tolerability and acceptability and effectiveness of statin-based therapy management of patients with a history of SAMS. We aim to provide evidence on the tolerability and different strategies of statin-based management of patients with a history of SAMS.Methods and analysisWe will conduct a systematic review of randomised controlled trials (RCTs) and non-randomised studies with a control group. We will search in Data sources MEDLINE, EMBASE, Cochrane Central Register of Controlled Clinical Trials, Scopus, Clinicaltrials.gov and Proquest from inception until April 2021. Two independent reviewers will carry out the study selection based on eligibility criteria. We will extract data following a standard data collection form. The reviewers will use the Cochrane Collaboration’s tools and Newcastle-Ottawa Scale to appraise the study risk of bias. Our primary outcome will be tolerability and our secondary outcomes will be acceptability and effectiveness. We will conduct a qualitative analysis of all included studies. In addition, if sufficient and homogeneous data are available, we will conduct quantitative analysis. We will synthesise dichotomous data using OR with 95% CI and continuous outcomes by using mean difference or standardised mean difference (with 95% CI). We will determine heterogeneity visually with forest plots and quantitatively with I2 and Q-test. We will summarise the confidence in the quantitative estimate by using Grading of Recommendations Assessment, Development and Evaluation approach.Ethics and disseminationAs a systematic review of literature without collection of new clinical data, there will be no requirement for ethical approval. We will disseminate findings through peer-reviewed publications.PROSPERO registration numberCRD42020202619.

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Relationship between hormonal contraceptives and sleep among women of reproductive age: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2020-045819 ◽

2021 ◽

Vol 11 (10) ◽

pp. e045819

Author(s):

Jinhui Ma ◽

Megan Cheng ◽

Lehana Thabane ◽

Caihong Ma ◽

Ning Zhang ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Research Question ◽

Risk Of Bias ◽

Reproductive Age ◽

Hormonal Contraceptives ◽

Controlled Trials ◽

Cochrane Central Register ◽

Women Of Reproductive Age

IntroductionThe aetiology of sleep disruptions is unknown, but hormonal fluctuations during the menstrual cycle, pregnancy and menopause have been shown to potentially affect how well a woman sleeps. The aim of this systematic review was to investigate whether hormonal contraceptives are associated with a decreased quality of sleep and increased sleep duration in women of reproductive age.MethodsThis review will analyse data from randomised controlled trials or non-randomised comparative studies investigating the association between hormonal contraceptives and sleep outcomes among women of reproductive age. Reviews addressing the same research question with similar eligibility criteria will be included. A literature search will be performed using the MEDLINE, Embase and Cochrane Central Register of Controlled Trials databases from inception to 7 March 2021. The Cochrane Collaboration’s Risk of Bias for Randomised Trials V.2.0 and The Risk of Bias for Non-randomised Studies of Interventions tool will be used to assess risk of bias for each outcome in eligible studies. Two reviewers will independently assess eligibility of studies and risk of bias and extract the data. All extracted data will be presented in tables and narrative form. For sleep measures investigated by two or more studies with low heterogeneity, we will conduct random-effects meta-analysis to estimate the magnitude of the overall effect of hormonal contraceptives. If studies included in this systematic review form a connected network, a network meta-analysis will be conducted to estimate the comparative effect of different contraceptives. The Grading of Recommendations, Assessment, Development, and Evaluation approach will be used to summarise the quality of evidence. Our protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols 2015 guidelines.Ethics and disseminationEthics approval is not required as data were sourced from previously reported studies. The findings of this review will be published in a peer-reviewed journal and presented at relevant conferences.PROSPERO registration numberCRD42020199958.

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Effects of Selenium Supplementation on Graves’ Disease: A Systematic Review and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2018/3763565 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 4

Author(s):

Huijuan Zheng ◽

Junping Wei ◽

Liansheng Wang ◽

Qiuhong Wang ◽

Jing Zhao ◽

...

Keyword(s):

Systematic Review ◽

Thyroid Function ◽

Meta Analysis ◽

Selenium Supplementation ◽

Control Group ◽

Graves Disease ◽

Cochrane Central Register ◽

Placebo Administration ◽

Increased Risk ◽

Tsh Levels

Low selenium status is associated with increased risk of Graves’ disease (GD). While several trials have discussed the efficacy of selenium supplementation for thyroid function, in GD patients, the effectiveness of selenium intake as adjuvant therapy remains unclear. In this systematic review and meta-analysis, we aimed to determine the efficacy of selenium supplementation on thyroid function in GD patients. Two reviewers searched PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, and four Chinese databases for studies published up to October 31, 2017. RCTs comparing the effect of selenium supplementation on thyroid hyperfunction in GD patients on antithyroid medication to placebo were included. Serum free thyroxine (FT4), free triiodothyronine (FT3), thyrotrophic hormone receptor antibody (TRAb), and thyroid-stimulating hormone (TSH) levels were assessed. Ten trials involving 796 patients were included. Random-effects meta-analyses in weighted mean difference (WMD) were performed for 3, 6, and 9 months of supplementation and compared to placebo administration. Selenium supplementation significantly decreased FT4 (WMD=-0.86 [confidence interval (CI)-1.20 to -0.53]; p=0.756; I2=0.0%) and FT3 (WMD=-0.34 [CI-0.66 to -0.02]; p=0.719; I2=0.0%) levels at 3 months, compared to placebo administration; these findings were consistent at 6 but not 9 months. TSH levels were more elevated in the group of patients taking selenium than in the control group at 3 and 6, but not 9 months. TRAb levels decreased at 6 but not 9 months. At 6 months, patients on selenium supplementation were more likely than controls to show improved thyroid function; however, the effect disappeared at 9 months. Whether these effects correlate with clinically relevant measures remains to be demonstrated.

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Digital telemedicine interventions for patients with multimorbidity: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-036904 ◽

2020 ◽

Vol 10 (10) ◽

pp. e036904

Author(s):

Christian Kraef ◽

Marc van der Meirschen ◽

Caroline Free

Keyword(s):

Systematic Review ◽

Health Status ◽

Usual Care ◽

Total Cholesterol ◽

Meta Analysis ◽

Perceived Health ◽

Absolute Difference ◽

Control Group ◽

Cochrane Central Register ◽

Perceived Health Status

ObjectiveTo determine the effectiveness of digital telemedicine interventions designed to improve outcomes in patients with multimorbidity.DesignSystematic review and meta-analysis of available literature.Data sourcesMEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the Database of Abstracts of Reviews of Effectiveness and hand searching. The search included articles from inception to 19 April 2019 without language restrictions. The search was updated on 7 June 2020 without additional findings.Eligibility criteriaProspective interventional studies reporting multimorbid participants employing interventions with at least one digital telemedicine component were included. Primary outcomes were patient physical or mental health outcomes, health-related quality of life scores and the utilisation of health services.ResultsOut of 5865 studies initially identified, 7 articles, reporting on 6 studies were retained (total of 699 participants). Four of these studies reported interventions including integration with usual care, two studies had interventions with no links to usual patient care. Follow-up periods lasted between 2 and 6 months. Among the studies with links to usual care, the primary outcomes were systolic blood pressure (SBP) (three studies), haemoglobin A1c (HbA1c) (three studies), total cholesterol (two studies) and self-perceived health status (one study). The evidence ranged from very low to moderate certainty. Meta-analysis showed a moderate decrease in SBP (8 mm Hg (95% CI 4.6 to 11.4)), a small to moderate decrease in HbA1c (0.46 mg/dL (95% CI 0.25 to 0.67)) and moderate decrease in total cholesterol (cholesterol 16.5 mg/dL (95% CI 8.1 to 25.0)) in the intervention groups. There was an absence of evidence for self-perceived health status. Among the studies with no links to usual care, time to hospitalisation (median time to hospitalisation 113.4 days intervention and 104.7 days control group, absolute difference 12.7 days) and the Minnesota Living with Heart Failure Questionnaire (intervention group 35.2 score points, control group 23.9 points, absolute difference 11.3, 95% CI 5.5 to 17.1) showed small reductions. The Personal Health Questionnaire (PHQ-8) showed no evidence of improvement (intervention 7.6 points, control 8.6 points, difference 1.0 points, 95% CI −22.9% to 11.9%).ConclusionDigital telemedicine interventions provided moderate evidence of improvements in measures of disease control but little evidence and no demonstrated benefits on health status. Further research is needed with clear descriptions of conditions, interventions and outcomes based on patients’ and healthcare providers’ preferences.PROSPERO registration numberCRD42019134872.

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Associations of childhood exposure to malaria with cognition and behaviour outcomes: a systematic review protocol

10.21203/rs.3.rs-19683/v3 ◽

2020 ◽

Author(s):

ANDREW SENTOOGO SSEMATA ◽

JACQUELLINE ANN NAKITENDE ◽

SIMON KIZITO ◽

ELIZABETH C WHIPPLE ◽

PAUL BANGIRANA ◽

...

Keyword(s):

Systematic Review ◽

Malaria Infection ◽

Meta Analysis ◽

Interrupted Time Series ◽

Bibliographic Databases ◽

Future Research ◽

Control Group ◽

Cochrane Central Register ◽

Eligibility Criteria ◽

Cross Sectional

Abstract Background: Malaria is one of the major contributing risk factors for poor development of children living in low- and middle- income countries (LMICs). However, little is known about the specific domains of cognition and behaviour that are impacted by malaria, the extent of these deficits, and the different types of the malaria spectrum that are associated with these deficits. The objective of this systematic review is to determine the association of the different type of malaria infection on cognition and behavioural outcomes among children living in LMICs. Methods and analysis: We will systematically search online bibliographic databases including MEDLINE (via PubMed), CINAHL (via EBSCO), PsycINFO (via EBSCO), Embase and The Cochrane Central Register of Controlled Trials (CENTRAL) as well as Google Scholar and bibliographies of pertinent articles. We will include studies with a comparison group (e.g., clinical trials, cohort, observational, cross-sectional case–control and controlled before and after or interrupted–time–series studies) involving children under 18 years of age living in LMICs, as determined by World Bank Criteria, with either an active malaria infection or history of malaria. Included articles must also measure cognitive and/or behaviour outcomes determined by standardized psychological assessments (questionnaire-based scales and or neurocognitive assessments). Studies will be excluded if they are not in English, lack a control group, take place in a high-income country, or if a standardized instrument was not used. Two reviewers will independently review all articles to determine if they meet eligibility criteria. Any conflicts will be resolved after discussion with a third reviewer. When a list of included articles is finalized, two reviewers will extract data to populate and then cross check within an electronic table. Risk of bias and the strength of evidence and recommendations will be assessed independently using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, and a final score will be given upon consensus. For sufficiently homogeneous data on measured outcomes in multiple studies, we will investigate the possibility of pooling data to perform a meta-analysis. Discussion: This systematic review will evaluate the evidence of the association of malaria on the cognitive and behavioural outcomes. Findings from this planned review will generate insight on the domains affected by the different forms malaria infection and may inform subsequent malaria interventions and future research in paediatric care.Systematic review registration: This systematic review has been registered under the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42020154777)

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Influenza vaccination in patients with heart failure: a systematic review and meta-analysis of observational studies

Heart ◽

10.1136/heartjnl-2019-315193 ◽

2019 ◽

Vol 106 (5) ◽

pp. 350-357 ◽

Cited By ~ 11

Author(s):

Bárbara Sucena Rodrigues ◽

Cláudio David ◽

João Costa ◽

Joaquim J Ferreira ◽

Fausto J Pinto ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Influenza Vaccination ◽

Influenza Infection ◽

Meta Analysis ◽

Risk Of Bias ◽

Control Group ◽

High Morbidity ◽

Cochrane Central Register ◽

All Cause Mortality

ObjectiveDespite the progression of treatments over decades, heart failure (HF) is a disease with high morbidity, mortality and economic burden. Influenza infection is an important trigger for cardiovascular (CV) events, including HF. Influenza vaccination has been seen to reduce the risk of CV mortality in patients with coronary disease, but the effect in patients with HF is still unclear. Therefore, we conducted a systematic review to evaluate the effect of influenza vaccination in the morbimortality of patients with HF.MethodsMEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Health Technology Assessment and PsycINFO databases (December 2018) were searched for longitudinal studies evaluating influenza vaccination compared with a non-vaccination control group in patients with HF. The risk of bias was assessed according to the ROBINS-I tool. We performed a random-effects meta-analysis to estimate the pooled HRs with 95% CIs, and heterogeneity was evaluated using the I2 statistics.ResultsSix cohort studies evaluating 179 158 patients with HF were included in the meta-analysis. Influenza vaccination was associated with a lower risk of all-cause mortality (HR=0.83; 95% CI 0.76 to 0.91; I2=75%). The effect of the influenza vaccination was not statistically significant in a pooled analysis of CV mortality (HR=0.92, 95% CI 0.73 to 1.15; 2 studies) and of all-cause hospitalisations (HR=1.01, 95% CI 0.92 to 1.11; 2 studies). The majority of outcomes in the included studies had a serious risk of bias and almost all evaluated outcomes had very low Grading of Recommendation, Assessment, Development and Evaluation (GRADE) evidence.ConclusionsInfluenza vaccination was associated with a significant decrease in all-cause mortality risk in patients with HF.

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The Effects of Exercise on BDNF Levels in Adolescents: A Systematic Review with Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176056 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6056

Author(s):

Kesley Pablo Morais de Azevedo ◽

Victor Hugo de Oliveira ◽

Gidyenne Christine Bandeira Silva de Medeiros ◽

Ádala Nayana de Sousa Mata ◽

Daniel Ángel García ◽

...

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Control Group ◽

Controlled Trials ◽

Cochrane Central Register ◽

Exercise Programs ◽

Randomized Controlled ◽

Central Register ◽

Before And After

The aim of this study was to analyze the evidence available in the literature about the effects of exercise on brain-derived neurotrophic factor levels in adolescents. The literature searches were conducted in PubMed, Embase, Scopus, ScienceDirect, Web of Science, SportDiscus, the Cochrane Central Register of Controlled Trials (CENTRAL) and CINAHL. Randomized controlled trials and non-randomized controlled trials performed with adolescents (10–19 years) who underwent different exercise programs and who evaluated BDNF levels before and after the intervention were included. We included six studies, four RCTs and two non-RCTs in the systematic review with a total of 407 adolescents. In two randomized trials and one non-RCT, the intervention groups showed significant improvements in BDNF levels compared with the control group. The results presented in the meta-analysis indicate that despite the positive effect in favor of the intervention, there were no significant differences (standardized mean difference 0.28 ng/mL, 95% confidence interval −0.28 to 0.85; p = 0.32, I² = 0%). The results presented in our review indicate that aerobic exercise programs practiced in moderate- or high-intensity are promising strategies to increase BDNF levels in adolescents. However, further studies are required to support this finding.

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Local anaesthetics combined with vasoconstrictors in patients with cardiovascular disease undergoing dental procedures: systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-044357 ◽

2021 ◽

Vol 11 (7) ◽

pp. e044357

Author(s):

Caio Chaves Guimaraes ◽

Luciane Cruz Lopes ◽

Cristiane de Cássia Bergamaschi ◽

Juliana Cama Ramacciato ◽

Marcus Tolentino Silva ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Intervention Group ◽

Local Anaesthetics ◽

Control Group ◽

Controlled Trials ◽

Cochrane Central Register ◽

Quality Of Evidence ◽

Dental Procedures

ObjectivesThere is a lack of evidence about the use of local anaesthetics (LAs) in patients with cardiovascular diseases (CVD) in dental procedures. Thus, this study evaluated the safety of using LA with vasoconstrictor to determine the risk of cardiovascular events in patients with CVD.DesignSystematic review and meta-analysis.MethodsWe have searched in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid), EMBASE (via Ovid), Healthstar (via Ovid), CINAHL, Web of Science and ClinicalTrials.gov for randomised controlled trials (RCTs) up to January 2020. We have included RCTs involving adults with CVD within two groups: intervention group with LA with vasoconstrictor and control group with LA without vasoconstrictor. The primary outcomes assessed were death, mortality by a specific cause, stroke, acute myocardial infarction, hospitalisation, pain, bleeding and arrhythmias. The secondary outcomes were ST segment depression, anxiety, adverse effects and changes in haemodynamic parameters. The data were pooled using random effects meta-analyses and the confidence in the estimates was verified using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).ResultsTen RCTs (n=478 participants) were included. Most of them had a high risk of bias. There were more cases of pain and bleeding in groups without vasoconstrictor. Meta-analysis demonstrated a decrease in the systolic blood pressure with the use of LA with vasoconstrictor (standard mean difference −0.95, 95% CI −1.35 to −0.55) after procedure. Overall, for the other outcomes assessed there was no statistical difference. The quality of evidence was considered low according to the GRADE profile.ConclusionsThe results suggest that the use of LA with vasoconstrictors (epinephrine in low doses) is safe in patients with some types of CVD. However, the low quality of evidence demonstrated that literature needs further studies in order to confirm these results.Protocol registrationPROSPERO (CRD42016045421).

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Factors Influencing an Eruption of Teeth Associated with a Dentigerous Cyst. A Systematic Review

10.21203/rs.3.rs-92689/v1 ◽

2020 ◽

Author(s):

Marek Nahajowski ◽

Sylwia Hnitecka ◽

Michał Sarul ◽

Kornelia Rumin ◽

Magdalena Dubowik ◽

...

Keyword(s):

Systematic Review ◽

Research Question ◽

Dentigerous Cyst ◽

Risk Of Bias ◽

Cochrane Central Register ◽

Alveolar Process ◽

Cyst Size ◽

High Quality Research ◽

Follicular Cyst ◽

Dentigerous Cysts

Abstract AimThis systematic review aimed to identify factors conducive/inconducive to a spontaneous eruption of teeth after a dentigerous cyst's marsupialization.MethodsIn accordance with the PRISMA guidelines, the main research question was defined in the PICO format (P: patients with dentigerous cysts, I: spontaneous eruption after surgery, C: forced eruption, O: determining factors potentially influencing the intervention or the comparison). The MEDLINE, the EMBASE, and the Cochrane Central Register of Controlled Trials databases were searched for the keywords combining dentigerous/odontogenic/follicular cyst with teeth and/or orthodontics, as well as human teeth and eruption pattern/interval/period/duration. The qualified articles (4 out of 3005 found initially) provided following data: a rate of tooth eruption after surgical treatment of the cyst, along with age and gender of patients, a perpendicular projection distance between the top of the tooth cusp and the edge of the alveolar process, tooth angulation, a root formation stage, the cyst size, and space to erupt. The articles underwent analysis of the risk of bias and quality, with the ROBINS-I protocol and the modified Newcastle-Ottawa QAS, respectively. The systematic review was registered in PROSPERO under ID CRD42020189044.ResultsA real risk of bias was assessed as critical, while the quality of the studies was considered high (7-9 points in 9-point scale). Small distance between the top of a tooth cusp and the edge of the alveolar process, and space for eruption larger than tooth dimensions were the factors likely to favor spontaneous eruption. The cyst size was irrelevant, while the influence of the other factors could not be determined from the available data. ConclusionA small number of published studies, as well as their heterogeneity and the critical risk of bias do not allow creating the evidence-based protocol of management the teeth with DC after its marsupialization. More high-quality research is needed to be able to draw more reliable conclusions.

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Intravenous corticosteroid treatment in adult patients with sepsis defined by the Sepsis-3 criteria: a systematic review and meta-analysis

10.1101/2021.10.17.21265100 ◽

2021 ◽

Author(s):

Yu-Pu Wu ◽

Cheng-Kuan Lin ◽

Rikuta Hamaya ◽

Fei-Yang Huang ◽

Yung-Shin Chien ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Standard Of Care ◽

Corticosteroid Treatment ◽

Adult Patients ◽

Control Group ◽

Cochrane Central Register ◽

Random Effects Models ◽

Intravenous Corticosteroid ◽

Registration Number

Objectives: To summarize the effects of intravenous corticosteroid treatment for sepsis defined by the Sepsis-3 criteria in adult patients. Design: Systematic review and meta-analysis. Methods: We searched RCTs from PubMed, Embase, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, Web of Science, and International Clinical Trials Registry Platform from inception to July 12th, 2019 and updated on June 28th, 2020. Conference proceedings from relevant societies and the reference lists of previous reviews were manually screened. Abstract or full-text articles were screened by two independent investigators. We included RCTs where (1) the participants had infections and the baseline Sequential Organ Failure Assessment (SOFA) score ≥ 2 (the Sepsis-3 definitions) (2) the intervention involved any intravenous corticosteroids; (3) the control group received placebo or standard of care (4) the outcomes of interest included mortality or clinical recovery. We chose the 28-day mortality as the pre-specified primary outcome and risk ratio (RR) as the effect measure. We followed PRISMA guidelines and chose random-effects models for the pooled analyses. Results: This study included 24 RCTs and 19 of them (7,115 participants) reported the 28-day mortality. Pooled analyses showed that intravenous corticosteroid treatment compared to placebo or standard of care was not associated with a lower risk of 28-day mortality (RR, 0.88; 95%CI, 0.73 to 1.05), but with a higher risk of hyperglycemia (RR, 1.16; 95%CI, 1.06 to 1.27). Sensitivity analysis of high-quality studies revealed a similar result for the 28-day mortality (RR, 0.95; 95%CI, 0.86 to 1.05). Conclusions: Our findings suggested that intravenous corticosteroids compared to placebo or standard of care may not reduce the 28-day mortality in adult patients with sepsis defined by the Sepsis-3 criteria. Further studies are warranted to clarify the roles of disease severity and treatment timing in the effects of corticosteroid treatment in this population. PROSPERO registration number: CRD42019143083

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