[A meta-analysis to evaluate the effects of corticosteroids on the outcomes of patients with septic shock].

Objective: To evaluate the effect of corticosteroids on the prognosis of patients with septic shock. Method: In order to compare administration of corticosteroids with placebo or standard supportive care in adults with septic shock, clinical randomized controlled trials (RCT) were searched and selected, according to inclusion and exclusion criteria. A systemic assessment and meta-analysis was performed using RevMan 5.3. Result: A total of 16 RCTs enrolling 6 896 patients were finally included in present analysis. The corticosteroids group included 3 448 patients, and the control group included 3 448 patients. The 28-day mortality in corticosteroids group and control group were 28.6% and 31.2%, respectively (P=0.16). The 90-day mortality, the mortality in intensive care unit (ICU) and the mortality in the hospital between corticosteroids group and control group were 31.7% vs. 34.0% (P=0.16), 37.5% vs. 37.5% (P=0.87), and 41.0% vs. 43.9% (P=0.35) respectively, which indicated that corticosteroids could not improve the mortality of patients with septic shock. Subgroup analyses showed that hydrocortisone combined with hydrocortisone could reduce the 28-day mortality, and the 28-day mortality in corticosteroids group and control group were 37.7% and 43.3%, respectively (P=0.02). However, other types of corticosteroids had no influence on 28-day mortality. The incidence of gastrointestinal hemorrhage and super-infections showed no statistical difference in corticosteroids group and control group. However, incidence of hyperglycemia was significantly increased in corticosteroids group, 27.1% vs. 25% (P<0.000 1). Conclusion: Corticosteroids could not improve the mortality of patients with septic shock, and simultaneously, significantly increase incidence of hyperglycemia. Corticosteroids have no influence on the incidence of gastrointestinal hemorrhage and super-infections. Subgroup analyses showed that hydrocortisone combined with hydrocortisone could reduce the 28-day mortality.目的： 评价不同类型糖皮质激素治疗对感染性休克患者预后的影响。 方法： 检索糖皮质激素治疗感染性休克患者的中英文临床随机对照研究，纳入关于糖皮质激素治疗感染性休克患者预后影响的随机对照试验，采用RevMan5.3软件对数据进行Meta分析，分析不同类型糖皮质激素治疗对感染性休克患者预后的影响。 结果： 纳入16篇临床随机对照研究共6 896例感染性休克患者。与对照组比，糖皮质激素治疗组患者28 d病死率（P=0.16）、90 d病死率（P=0.16）、ICU病死率（P=0.87）、住院病死率（P=0.35）差异均无统计学意义。使用氢化可的松联合氟氢可的松治疗感染性休克患者28 d病死率明显低于对照组（RR=0.87, 95%CI 0.87 ~ 0.98, P=0.02）。糖皮质激素明显降低使用大剂量去甲肾上腺素的感染性休克患者的ICU病死率（RR=0.87, 95%CI 0.78 ~ 0.97，P=0.01）。使用糖皮质激素明显升高高血糖的发生率（RR=1.10, 95%CI 1.06 ~ 1.15, P<0.000 1）。 结论： 糖皮质激素不能改善感染性休克患者的病死率，氢化可的松联合氟氢可的松可改善感染性休克患者28 d病死率，糖皮质激素可降低使用大剂量血管活性药物的感染性休克患者的ICU病死率。.