ReviewIntensive care medicine2011
Low-dose steroids for septic shock and severe sepsis: the use of Bayesian statistics to resolve clinical trial controversies.
Review in Intensive care medicine, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03422159 (Outcomes of Metabolic Resuscitation Using Ascorbic Acid, Thiamine, and Glucocorticoids in the Early Treatment of Sepsis.), which is not on this map. Cited by 27 papers, 3 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.
Outcomes of Metabolic Resuscitation Using Ascorbic Acid, Thiamine, and Glucocorticoids in the Early Treatment of Sepsis.
Who cites it
27 citing papers in PubMed, 3 syntheses or guidelines pooled it, 61 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
- Corticosteroids for treating sepsis.The Cochrane database of systematic reviews · 2015Pooled 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
- Transcriptome modulation by hydrocortisone in severe burn shock: ancillary analysis of a prospective randomized trial.Critical care (London, England) · 2017Trial
- Article
- Death by p-value: the overreliance on p-values in critical care research.Critical care (London, England) · 2025Review
- Clinical trials in critical care: can a Bayesian approach enhance clinical and scientific decision making?The Lancet. Respiratory medicine · 2021Review
- Comparative Evaluation of the Treatment of COVID-19 with Multicriteria Decision-Making Techniques.Journal of healthcare engineering · 2021Article
- What is the role of rheumatologists in the era of COVID-19?Autoimmunity reviews · 2020Article
- Bayes factors for superiority, non-inferiority, and equivalence designs.BMC medical research methodology · 2019Article
- Hydrocortisone, Ascorbic Acid and Thiamine (HAT Therapy) for the Treatment of Sepsis. Focus on Ascorbic Acid.Nutrients · 2018Review
- Steroids for sepsis: yes, no or maybe.Journal of thoracic disease · 2018Article
- Treatment of Acute Kidney Injury Complicating Septic Shock with EMiC2 High-cutoff Hemofilter: Case Series.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2017Article
- Protective effect of early low-dose hydrocortisone on ventilator-associated pneumonia in the cancer patients: a propensity score analysis.Annals of intensive care · 2017Article
- The efficacy of steroids for postoperative persistent inflammatory reaction in a patient with barium peritonitis: A case report.International journal of surgery case reports · 2017Article
- Targeted Temperature Management After Cardiac Arrest Due to Drowning: "Frequentist" and "Bayesian" Decision Making.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2016Article
- The Role of ACTH and Corticosteroids for Sepsis and Septic Shock: An Update.Frontiers in endocrinology · 2016Review
- It's About Time ….Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2015Article
- Community-acquired pneumonia.Lancet (London, England) · 2015Review
Corrections and comments
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Authors and funding
2 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeLow-dose steroids have shown contradictory results in trials and three recent meta-analyses. We aimed to assess the efficacy and safety of low-dose steroids for severe sepsis and septic shock by Bayesian methodology.
methodsRandomized trials from three published meta-analyses were reviewed and entered in both classic and Bayesian databases to estimate relative risk reduction (RRR) for 28-day mortality, and relative risk increase (RRI) for shock reversal and side effects.
resultsIn septic shock trials only (Marik meta-analysis; N = 965), the probability that low-dose steroids decrease mortality by more than 15% (i.e., RRR > 15%) was 0.41 (0.24 for RRR > 20% and 0.14 for RRR > 25%). For severe sepsis and septic shock trials combined, the results were as follows: (1) for the Annane meta-analysis (N = 1,228), the probabilities were 0.57 (RRR > 15%), 0.32 (RRR > 20%), and 0.13 (RRR > 25%); (2) for the Minneci meta-analysis (N = 1,171), the probability was 0.57 to achieve mortality RRR > 15%, 0.32 (RRR > 20%), and 0.14 (RRR > 25%). The removal of the Sprung trial from each analysis did not change the overall results. The probability of achieving shock reversal ranged from 65 to 92%. The probability of developing steroid-induced side effects was as follows: for gastrointestinal bleeding (N = 924), there was a 0.73 probability of steroids causing an RRI > 1%, 0.70 for RRI > 2%, and 0.67 for RRI > 5%; for superinfections (N = 964), probabilities were 0.81 (RRI > 1%), 0.76 (RRI > 2%), and 0.70 (RRI > 5%); and for hyperglycemia (N = 540), 0.99 (RRI > 1%), 0.97 (RRI > 2%), and 0.94 (RRI > 5%).
conclusionsBased on clinically meaningful thresholds (RRR > 15-25%) for mortality reduction in severe sepsis or septic shock, the Bayesian approach to all three meta-analyses consistently showed that low-dose steroids were not associated with survival benefits. The probabilities of developing steroid-induced side effects (superinfections, bleeding, and hyperglycemia) were high for all analyses.
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.