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Corticosteroid therapy for sepsis: a clinical practice guideline

Research output: Contribution to journalArticle

Francois Lamontagne, Bram Rochwerg, Lyubov Lytvyn, Gordon H Guyatt, Morten Hylander Møller, Djillali Annane, Michelle E Kho, Neill K J Adhikari, Flavia Machado, Per O Vandvik, Peter Dodek, Rebecca Leboeuf, Matthias Briel, Madiha Hashmi, Julie Camsooksai, Manu Shankar-Hari, Mahder Kinfe Baraki, Karie Fugate, Shunjie Chua, Christophe Marti & 4 more Dian Cohen, Edouard Botton, Thomas Agoritsas, Reed A C Siemieniuk

Original languageEnglish
JournalBMJ
Volume362
DOIs
Publication statusPublished - 10 Aug 2018

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Abstract

What you need to knowSepsis is a syndrome of life threatening infection with organ dysfunction, and most guidelines do not advise use of corticosteroids to treat it in the absence of refractory shockTwo new trials of corticosteroid treatment for sepsis came to differing conclusionsCorticosteroids may reduce the risk of death by a small amount and increase neuromuscular weakness by a small amount, but the evidence is not definitive This guideline makes a weak recommendation for corticosteroids in patients with sepsis; both steroids and no steroids are reasonable management optionsFully informed patients who value avoiding death over quality of life and function would likely choose corticosteroidsDo corticosteroids reduce death or improve recovery in people with sepsis or septic shock? Our panel make a weak recommendation to give corticosteroids to people with all types and severity of sepsis, based on new evidence. Because we are not certain that they are beneficial, it is also reasonable not to prescribe them. Patients’ values and preferences may guide this decision-making process.This rapid recommendation was triggered by two trials, with differing conclusions whose results might change practice:ADRENAL (3658 patients who had septic shock) found no statistically significant difference in 90 day mortality between the hydrocortisone and placebo groups.1APROCCHSS (1241 patients who had septic shock) found that hydrocortisone plus fludrocortisone reduced 90 day mortality.2The trials are incorporated into a linked systematic review comparing corticosteroids with placebo.3 This BMJ Rapid Recommendation promptly and transparently translates this evidence using GRADE methodology for trustworthy guidelines. Sepsis is a life threatening organ dysfunction from infection. Currently most guidelines advise against giving corticosteroids in sepsis in the absence of refractory shock, but these guidelines have not taken into account the new evidence. We do not anticipate that new clinical trials will substantively alter the evidence …

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