SynthesisThe Cochrane database of systematic reviews2004
Corticosteroids for treating severe sepsis and septic shock.
Synthesis in The Cochrane database of systematic reviews, 2004. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00670254 (Placebo-controlled, Randomised, Double-blind Study to Investigate the Efficacy and Safety of Low Dose Hydrocortisone to Prevent the Development of Septic Shock in Patients With Severe Sepsis), which is not on this map. Cited by 30 papers, 9 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Placebo-controlled, Randomised, Double-blind Study to Investigate the Efficacy and Safety of Low Dose Hydrocortisone to Prevent the Development of Septic Shock in Patients With Severe Sepsis
Who cites it
30 citing papers in PubMed, 9 syntheses or guidelines pooled it, 110 citations in OpenAlex.
- Corticosteroids for treating sepsis in children and adults.The Cochrane database of systematic reviews · 2025Pooled it
- Corticosteroids for treating sepsis in children and adults.The Cochrane database of systematic reviews · 2019Pooled it
- Impact and Beneficial Critical Points of Clinical Outcome in Corticosteroid Management of Adult Patients With Sepsis: Meta-Analysis and GRADE Assessment.Frontiers in pharmacology · 2019Pooled it
- High-volume haemofiltration for sepsis in adults.The Cochrane database of systematic reviews · 2017Pooled it
- Corticosteroids for treating sepsis.The Cochrane database of systematic reviews · 2015Pooled it
- Comparative effect sizes in randomised trials from less developed and more developed countries: meta-epidemiological assessment.BMJ (Clinical research ed.) · 2013Pooled it
- Clinical review: Critical illness polyneuropathy and myopathy.Critical care (London, England) · 2008Pooled it
- Clinical review: a systematic review of corticosteroid use in infections.Critical care (London, England) · 2006Pooled it
- Corticosteroids for severe sepsis and septic shock: a systematic review and meta-analysis.BMJ (Clinical research ed.) · 2004Pooled it
- Trial
- Decoding Sepsis-Induced Disseminated Intravascular Coagulation: A Comprehensive Review of Existing and Emerging Therapies.Journal of clinical medicine · 2023Review
- Should all adjunctive corticosteroid therapy be avoided in the management of hemodynamically stabile Staphylococcus aureus bacteremia?European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2016Article
- Sepsis in the intensive care unit.Surgery (Oxford, Oxfordshire) · 2015Review
- Corticosteroids in the treatment of dengue shock syndrome.Infection and drug resistance · 2014Review
- The Effect of Adrenal Replacement Therapy on Rates of Fungal Colonization and Mortality in Critically Ill Patients Awaiting Liver Transplantation.Journal of clinical and translational hepatology · 2013Article
- Severe community-acquired pneumonia.Critical care clinics · 2013Review
- Pneumonia in adults: the practical emergency department perspective.Emergency medicine clinics of North America · 2012Article
- Thyroid hormone enhances nitric oxide-mediated bacterial clearance and promotes survival after meningococcal infection.PloS one · 2012Article
- Pathophysiology of acute respiratory distress syndrome. Glucocorticoid receptor-mediated regulation of inflammation and response to prolonged glucocorticoid treatment.Presse medicale (Paris, France : 1983) · 2011Review
- Corticosteroids for severe sepsis: an evidence-based guide for physicians.Annals of intensive care · 2011Article
Corrections and comments
- Commented on by
- Updated by
Authors and funding
6 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSepsis may be complicated by impaired corticosteroid production. Giving corticosteroids could potentially benefit patients.
objectivesTo examine the effects of corticosteroids on death at one month in patients with severe sepsis and septic shock. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group's trial register (August 2003), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2003), MEDLINE (August 2003), EMBASE (August 2003), LILACS (August 2003), reference lists of articles, and also contacted trial authors. SELECTION CRITERIA: Randomized and quasi-randomized controlled trials of corticosteroids versus placebo or supportive treatment in severe sepsis and septic shock. DATA COLLECTION AND ANALYSIS: Two pairs of reviewers agreed the eligibility of trials. One reviewer extracted data, which was checked by the other reviewers and the primary author of the paper whenever possible. We obtained some missing data from the trial authors. We assessed trial methodological quality. MAIN
resultsWe identified 15 trials (n =2023). Corticosteroids did not change 28-day all-cause mortality (15 trials, n = 2022, relative risk (RR) 0.92, 95% confidence interval (CI) 0.75 to 1.14; random effects model) and hospital mortality (13 trials, n = 1418, RR 0.89, 95% CI 0.71 to 1.11; random effects model); however, there was statistically significant heterogeneity, with some evidence that this was related to the dosing strategy. Corticosteroids reduced intensive care unit mortality (4 trials, n = 425, RR 0.83, 95% CI 0.70 to 0.97), increased the proportion of shock reversal by day 7 (6 trials, n = 728, RR 1.22, 95% CI 1.06 to 1.40) and by day 28 (4 trials, n = 425, RR 1.26, 95% CI 1.04 to 1.52), without increasing the rate of gastroduodenal bleeding (10 trials, n = 1321, RR 1.16, 95% CI 0.82 to 1.65), superinfection (12 trials, n = 1705, RR 0.93, 95% CI 0.73 to 1.18), and of hyperglycaemia (6 trials, n = 608, RR 1.22, 0.84 to 1.78). REVIEWER'S
conclusionsOverall, corticosteroids did not change 28-day mortality and hospital mortality in severe sepsis and septic shock. Long course of low dose corticosteroids reduced 28-day all-cause mortality, and intensive care unit and hospital mortality.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.