SynthesisBMJ (Clinical research ed.)2004
Corticosteroids for severe sepsis and septic shock: a systematic review and meta-analysis.
Synthesis in BMJ (Clinical research ed.), 2004. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00732277 (Evaluation of Corticosteroid Therapy in Childhood Severe Sepsis), which is not on this map. Cited by 88 papers, 13 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.
Evaluation of Corticosteroid Therapy in Childhood Severe Sepsis (Steroids in Paediatric Sepsis, StePS) - a Randomised Pilot Study
Who cites it
88 citing papers in PubMed, 13 syntheses or guidelines pooled it.
- Corticosteroids as adjunctive therapy in the treatment of influenza.The Cochrane database of systematic reviews · 2019Pooled it
- Association of Corticosteroid Treatment With Outcomes in Adult Patients With Sepsis: A Systematic Review and Meta-analysis.JAMA internal medicine · 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
- Are Corticosteroids Beneficial for Sepsis and Septic Shock? Based on Pooling Analysis of 16 Studies.Frontiers in pharmacology · 2019Pooled it
- Meta-analysis of the accuracy of transient elastography in measuring liver stiffness to diagnose esophageal varices in cirrhosis.Medicine · 2018Pooled it
- Corticosteroids for pneumonia.The Cochrane database of systematic reviews · 2017Pooled it
- Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients.The Cochrane database of systematic reviews · 2015Pooled it
- [Corticosteroid administration for acute respiratory distress syndrome : therapeutic option?].Der Anaesthesist · 2012Pooled it
- Bundled care for septic shock: an analysis of clinical trials.Critical care medicine · 2010Pooled it
- Updating the evidence for the role of corticosteroids in severe sepsis and septic shock: a Bayesian meta-analytic perspective.Critical care (London, England) · 2010Pooled it
- The effects of steroids during sepsis depend on dose and severity of illness: an updated meta-analysis.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2009Pooled it
- The role of corticosteroids in severe community-acquired pneumonia: a systematic review.Critical care (London, England) · 2008Pooled it
- Clinical review: a systematic review of corticosteroid use in infections.Critical care (London, England) · 2006Pooled it
- Pre-emptive hydrocortisone therapy in early septic shock: a double-blind, allocation-concealed, pilot randomized controlled trial.Daru : journal of Faculty of Pharmacy, Tehran University of Medical Sciences · 2025Trial
- Trial
- Corticosteroids and transition to delirium in patients with acute lung injury.Critical care medicine · 2014Trial
- Low doses of fludrocortisone and hydrocortisone, alone or in combination, on vascular responsiveness to phenylephrine in healthy volunteers.British journal of clinical pharmacology · 2013Trial
- Gluco- and mineralocorticoid biological effects of a 7-day treatment with low doses of hydrocortisone and fludrocortisone in septic shock.Intensive care medicine · 2012Trial
- The effects of etomidate on adrenal responsiveness and mortality in patients with septic shock.Intensive care medicine · 2009Trial
- Trial
28 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess the effects of corticosteroids on mortality in patients with severe sepsis and septic shock. DATA SOURCES: Randomised and quasi-randomised trials of corticosteroids versus placebo (or supportive treatment alone) retrieved from the Cochrane infectious diseases group's trials register, the Cochrane central register of controlled trials, Medline, Embase, and LILACS. REVIEW
methodTwo pairs of reviewers agreed on eligibility of trials. One reviewer entered data on to the computer and four reviewers checked them. We obtained some missing data from authors of trials and assessed methodological quality of trials.
results16/23 trials (n = 2063) were selected. Corticosteroids did not change 28 day mortality (15 trials, n = 2022; relative risk 0.92, 95% confidence interval 0.75 to 1.14) or hospital mortality (13 trials, n = 1418; 0.89, 0.71 to 1.11). There was significant heterogeneity. Subgroup analysis on long courses (> or = 5 days) with low dose (< or = 300 mg hydrocortisone or equivalent) corticosteroids showed no more heterogeneity. The relative risk for mortality was 0.80 at 28 days (five trials, n = 465; 0.67 to 0.95) and 0.83 at hospital discharge (five trials, n = 465, 0.71 to 0.97). Use of corticosteroids reduced mortality in intensive care units (four trials, n = 425, 0.83, 0.70 to 0.97), increased shock reversal at 7 days (four trials, n = 425; 1.60, 1.27 to 2.03) and 28 days (four trials, n = 425, 1.26, 1.04 to 1.52) without inducing side effects.
conclusionsFor all trials, regardless of duration of treatment and dose, use of corticosteroids did not significantly affect mortality. With long courses of low doses of corticosteroids, however, mortality at 28 days and hospital morality was reduced.
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.