Corticosteroids Had no Effect on 28-Days Mortality in Adult Patients with sepsis: A Systematic Review and Meta-Analysis

Abstract Objective: Corticosteroids are a common option used in the treatment of sepsis. However, the efficacy and potential risk of corticosteroids in septic patients have not been well assessed. We performed this review to assess the efficacy and safety of corticosteroids in sepsis patients.Methods: We searched the PubMed, Embase, and Cochrane library databases from inception to March 2021. Randomized controlled trials (RCTs) that evaluated the effect of corticosteroids on septic patients were included. The quality of outcomes in the included articles was evaluated using the Grading of Recommendations Assessment, Development and Evaluation methodology. The data were pooled by using relative risk (RR) and mean difference (MD). The random-effects model were used to to eveluate the pooled MD or RR and 95% CI.Results: Fifty-three RCTs that included 12,310 patients with sepsis were identified. Corticosteroids were not associated with the mortality in 28-day (RR, 0.94; 95% CI, 0.87–1.02; evidence rank, moderate), and long-term mortality (>60 d) (RR, 0.96; 95% CI, 0.88–1.05) in septic patients (evidence rank, low). However, corticosteroids may exert a significant effect on the mortality in ICU (RR, 0.89; 95% CI, 0.80–0.98), in-hospital (RR, 0.93; 95% CI, 0.88–0.99; evidence rank, moderate) in patients with sepsis or septic shock (evidence rank, low). Furthermore, corticosteroids probably achieved a very small reductions in the length of hospital stay and ICU. Corticosteroids were associated with an higher risk of hypernatremia and hyperglycemia; further, they appear to have no significant effect on superinfection and gastroduodenal bleeding.Conclusions: Corticosteroids had no significant effect on the 28 and long-term mortality; however, they decreased the ICU and hospital mortality. Further, corticosteroids could increase the risk of the hypernatremia and hyperglycemia in sepsis patients.