Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is high or moderate to high where GRADE has been performed and there is a trade off between benefits and harms of the intervention.
Population: Children and adults with sepsis ᵃ
Intervention: Corticosteroids
Comparison: Placebo or standard therapy
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
All‐cause mortality (28 days) | Favors intervention ᵇ | Moderate |
Intensive care unit (ICU) mortality | Favors intervention | High |
Hospital mortality | Favors intervention | Moderate |
Shock reversal by day 7 | Favors intervention | Moderate |
Shock reversal by day 28 | Favors intervention | High |
Organ failure (sequential organ failure assessment [SOFA] score on day 7; scale 4-24) | Favors intervention | Moderate |
Duration of ICU stay (follow‐up: 14 days-1 year) | Favors intervention | High |
Duration of hospital stay (follow‐up: 14 days-1 year) | Favors intervention | High |
Adverse events (follow‐up: 14-90 days): hyperglycemia | Occurs more commonly with corticosteroids compared with placebo or standard therapy (favors comparison) | Moderate |
Adverse events (follow‐up: 14-90 days): hypernatremia; muscle weakness | Occur more commonly with corticosteroids compared with placebo or standard therapy (favors comparison) | High |
Note ᵃ Approximately 95% of the overall population included were adults. Some studies targeted sepsis with acute respiratory distress syndrome (ARDS) or community‐acquired pneumonia. However, the underlying condition was not reported for most studies. ᵇ The Cochrane Clinical Answer (CCA) noted that the evidence probably favored intervention (RR 0.91, 95% CI 0.84 to 0.99). Further, in subgroup analyses people with sepsis and ARDS or sepsis and community-acquired pneumonia benefited from corticosteroid use. However, in studies that looked at heterogeneous populations of people with sepsis there was no significant difference in 28 day mortality (RR 1.17, 95% CI 0.98 to 1.39).
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- How do colloids compare with crystalloids for fluid resuscitation in critically ill people?
- What are the effects of corticosteroids for people with sepsis?
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