Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Updating the evidence for the role of corticosteroids in severe sepsis and septic shock: a Bayesian meta-analytic perspective. | Moran et al. Critical Care 2010 14 R134 http content 14 4 R134 c CRITICAL CARE RESEARCH Open Access Updating the evidence for the role of corticosteroids in severe sepsis and septic shock a Bayesian meta-analytic perspective John L Moran1 Petra L Graham2 Sue Rockliff3 Andrew D Bersten4 Abstract Introduction Current low stress dose corticosteroid regimens may have therapeutic advantage in severe sepsis and septic shock despite conflicting results from two landmark randomised controlled trials RCT . We systematically reviewed the efficacy of corticosteroid therapy in severe sepsis and septic shock. Methods RCTs were identified 1950-September 2008 by multiple data-base electronic search MEDLINE via OVID OVID PreMedline OVID Embase Cochrane Central Register of Controlled trials Cochrane database of systematic reviews Health Technology Assessment Database and Database of Abstracts of Reviews of Effects and hand search of references reviews and scientific society proceedings. Three investigators independently assessed trial inclusion and data extraction into standardised forms differences resolved by consensus. Results Corticosteroid efficacy compared with control for hospital-mortality proportion of patients experiencing shock-resolution and infective and non-infective complications was assessed using Bayesian random-effects models expressed as odds ratio OR 95 credible-interval . Bayesian outcome probabilities were calculated as the probability P that OR 1. Fourteen RCTs were identified. High-dose 1000 mg hydrocortisone equivalent per day corticosteroid trials were associated with a null n 5 OR or higher n 4 OR outlier excluded mortality probability P and respectively . Low-dose trials 1000 mg hydrocortisone per day were associated with a lower n 9 OR n 8 OR outlier excluded mortality probability and respectively . OR for shock-resolution was increased in the low dose trials n 7
