Evidence map›Paper›PMID 28351429›Full record

SynthesisCritical care (London, England)2017

Corticosteroids in septic shock: a systematic review and network meta-analysis.

Ben Gibbison, José A López-López, Julian P T Higgins, Tom Miller, Gianni D Angelini, Stafford L Lightman, Djillali Annane

Open access · goldAbstract readSystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Critical care (London, England), 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 62 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
62citing papers in PubMed, 11 pooled it
9.8field-weighted citation impact, top 1% of its field
1 · What the graph read from 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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

62 citing papers in PubMed, 11 syntheses or guidelines pooled it, 131 citations in OpenAlex.

  1. Corticosteroids for treating sepsis in children and adults.The Cochrane database of systematic reviews · 2025
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  9. Corticosteroids for treating sepsis in children and adults.The Cochrane database of systematic reviews · 2019
    Pooled it
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  11. Guideline
  12. Low-Dose Hydrocortisone in Cirrhotic Patients With Septic Shock: A Double-Blind Randomised Placebo-Controlled Trial.Liver international : official journal of the International Association for the Study of the Liver · 2025
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2 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 2 countries.

Ben GibbisonCardiac Anaesthesia and Intensive Care, Bristol Heart Institute - University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK. mdbjjg@bristol.ac.uk.ORCID 0000-0003-3635-6212
José A López-LópezSchool of Social and Community Medicine, University of Bristol, Bristol, UK.
Julian P T HigginsCentre for Research Synthesis and Decision Analysis, School of Social and Community Medicine, University of Bristol, Bristol, UK.
Tom MillerCardiac Anaesthesia and Intensive Care, Bristol Heart Institute - University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.
Gianni D AngeliniCardiac Surgery, Bristol Heart Institute - University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.
Stafford L LightmanHenry Wellcome Laboratories for Integrative Neuroscience and Metabolism, School of Clinical Sciences, University of Bristol, Bristol, UK.
Djillali AnnaneMedicine: Critical Care Medicine, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris (APHP), Garches, France.
University Hospitals Bristol NHS Foundation Trust · GBUniversity of Bristol · GBUniversité de Versailles Saint-Quentin-en-Yvelines · FR

Funding

British Heart Foundation CH/1992027/7163
6 · The paper itself

Abstract

backgroundMultiple corticosteroids and treatment regimens have been used as adjuncts in the treatment of septic shock. Qualitative and quantitative differences exist at cellular and tissular levels between the different drugs and their patterns of delivery. The objective of this study was to elucidate any differences between the drugs and their treatment regimens regarding outcomes for corticosteroid use in adult patients with septic shock.

methodsNetwork meta-analysis of the data used for the recently conducted Cochrane review was performed. Studies that included children and were designed to assess respiratory function in pneumonia and acute respiratory distress syndrome, as well as cross-over studies, were excluded. Network plots were created for each outcome, and all analyses were conducted using a frequentist approach assuming a random-effects model.

resultsComplete data from 22 studies and partial data from 1 study were included. Network meta-analysis provided no clear evidence that any intervention or treatment regimen is better than any other across the spectrum of outcomes. There was strong evidence of differential efficacy in only one area: shock reversal. Hydrocortisone boluses and infusions were more likely than methylprednisolone boluses and placebo to result in shock reversal.

conclusionsThere was no clear evidence that any one corticosteroid drug or treatment regimen is more likely to be effective in reducing mortality or reducing the incidence of gastrointestinal bleeding or superinfection in septic shock. Hydrocortisone delivered as a bolus or as an infusion was more likely than placebo and methylprednisolone to result in shock reversal.

Indexed as

Adrenal Cortex HormonesAdultChildGastrointestinal HemorrhageHospital MortalityHumansShock, SepticAdrenal Cortex HormonesAdrenalCritical careGlucocorticoidsSepsisSeptic shockSteroids

Identifiers

PMID28351429
PMCPMC5371269
OpenAlexW2599659627

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.