Combination of low-dose glucocorticosteroids and mineralocorticoids as adjunct therapy for adult patients with septic shock: A systematic review and meta-analysis of randomized trials and observational studies

Background: The role of the combination of glucocorticosteroids and mineralocorticosteroids in treating septic shock is not well-defined. The aim of this study was to perform a systematic review and meta-analysis of the randomized controlled trials and observational studies assessing the effect of l...

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Autores principales:	Paraschos Archontakis Barakakis, Leonidas Palaiodimos, Derlis Fleitas Sosa, Linda Benes, Perminder Gulani, Daniel Fein
Formato:	article
Lenguaje:	EN
Publicado:	Thieme Medical and Scientific Publishers Pvt. Ltd. 2019
Materias:	fludrocortisone glucocorticosteroids hydrocortisone mineralocorticoids septic shock steroids Medicine R
Acceso en línea:	https://doaj.org/article/34fc74c1c65343909533545c45c81e2d
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spelling	oai:doaj.org-article:34fc74c1c65343909533545c45c81e2d2021-12-02T16:24:49ZCombination of low-dose glucocorticosteroids and mineralocorticoids as adjunct therapy for adult patients with septic shock: A systematic review and meta-analysis of randomized trials and observational studies2231-07702249-446410.4103/ajm.AJM_97_19https://doaj.org/article/34fc74c1c65343909533545c45c81e2d2019-10-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.4103/ajm.AJM_97_19https://doaj.org/toc/2231-0770https://doaj.org/toc/2249-4464Background: The role of the combination of glucocorticosteroids and mineralocorticosteroids in treating septic shock is not well-defined. The aim of this study was to perform a systematic review and meta-analysis of the randomized controlled trials and observational studies assessing the effect of low-dose hydrocortisone and fludrocortisone on patients with septic shock. Materials and Methods: MEDLINE, Scopus, and Cochrane databases were reviewed. A random effect model meta-analysis was used and I-square was used to assess the heterogeneity. Short-term mortality was chosen as our primary end point. A subgroup analysis was performed including only the randomized controlled trials. Results: A total of 10,550 patients were included in this meta-analysis. Administration of the steroid combination was associated with improved short-term mortality (odds ratio, 0.78, confidence interval, 0.64–0.96), intensive care unit mortality, and shock reversal, without increase in steroid-related side effects, such as secondary infection or gastrointestinal hemorrhage. Conclusion: This systematic review and meta-analysis showed that use of the combination of glucocorticosteroids and mineralocorticosteroids has a beneficial impact on short-term mortality, intensive care unit mortality, and shock reversal, without increasing the incidence of gastrointestinal hemorrhage or superinfection in patients with septic shock, when used as an adjunct treatment to the established standard of care.Paraschos Archontakis BarakakisLeonidas PalaiodimosDerlis Fleitas SosaLinda BenesPerminder GulaniDaniel FeinThieme Medical and Scientific Publishers Pvt. Ltd.articlefludrocortisoneglucocorticosteroidshydrocortisonemineralocorticoidsseptic shocksteroidsMedicineRENAvicenna Journal of Medicine, Vol 09, Iss 04, Pp 134-142 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	fludrocortisone glucocorticosteroids hydrocortisone mineralocorticoids septic shock steroids Medicine R
spellingShingle	fludrocortisone glucocorticosteroids hydrocortisone mineralocorticoids septic shock steroids Medicine R Paraschos Archontakis Barakakis Leonidas Palaiodimos Derlis Fleitas Sosa Linda Benes Perminder Gulani Daniel Fein Combination of low-dose glucocorticosteroids and mineralocorticoids as adjunct therapy for adult patients with septic shock: A systematic review and meta-analysis of randomized trials and observational studies
description	Background: The role of the combination of glucocorticosteroids and mineralocorticosteroids in treating septic shock is not well-defined. The aim of this study was to perform a systematic review and meta-analysis of the randomized controlled trials and observational studies assessing the effect of low-dose hydrocortisone and fludrocortisone on patients with septic shock. Materials and Methods: MEDLINE, Scopus, and Cochrane databases were reviewed. A random effect model meta-analysis was used and I-square was used to assess the heterogeneity. Short-term mortality was chosen as our primary end point. A subgroup analysis was performed including only the randomized controlled trials. Results: A total of 10,550 patients were included in this meta-analysis. Administration of the steroid combination was associated with improved short-term mortality (odds ratio, 0.78, confidence interval, 0.64–0.96), intensive care unit mortality, and shock reversal, without increase in steroid-related side effects, such as secondary infection or gastrointestinal hemorrhage. Conclusion: This systematic review and meta-analysis showed that use of the combination of glucocorticosteroids and mineralocorticosteroids has a beneficial impact on short-term mortality, intensive care unit mortality, and shock reversal, without increasing the incidence of gastrointestinal hemorrhage or superinfection in patients with septic shock, when used as an adjunct treatment to the established standard of care.
format	article
author	Paraschos Archontakis Barakakis Leonidas Palaiodimos Derlis Fleitas Sosa Linda Benes Perminder Gulani Daniel Fein
author_facet	Paraschos Archontakis Barakakis Leonidas Palaiodimos Derlis Fleitas Sosa Linda Benes Perminder Gulani Daniel Fein
author_sort	Paraschos Archontakis Barakakis
title	Combination of low-dose glucocorticosteroids and mineralocorticoids as adjunct therapy for adult patients with septic shock: A systematic review and meta-analysis of randomized trials and observational studies
title_short	Combination of low-dose glucocorticosteroids and mineralocorticoids as adjunct therapy for adult patients with septic shock: A systematic review and meta-analysis of randomized trials and observational studies
title_full	Combination of low-dose glucocorticosteroids and mineralocorticoids as adjunct therapy for adult patients with septic shock: A systematic review and meta-analysis of randomized trials and observational studies
title_fullStr	Combination of low-dose glucocorticosteroids and mineralocorticoids as adjunct therapy for adult patients with septic shock: A systematic review and meta-analysis of randomized trials and observational studies
title_full_unstemmed	Combination of low-dose glucocorticosteroids and mineralocorticoids as adjunct therapy for adult patients with septic shock: A systematic review and meta-analysis of randomized trials and observational studies
title_sort	combination of low-dose glucocorticosteroids and mineralocorticoids as adjunct therapy for adult patients with septic shock: a systematic review and meta-analysis of randomized trials and observational studies
publisher	Thieme Medical and Scientific Publishers Pvt. Ltd.
publishDate	2019
url	https://doaj.org/article/34fc74c1c65343909533545c45c81e2d
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Combination of low-dose glucocorticosteroids and mineralocorticoids as adjunct therapy for adult patients with septic shock: A systematic review and meta-analysis of randomized trials and observational studies

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