Updating the evidence for the role of corticosteroids in severe sepsis and septic shock a Bayesian meta-analytic perspective 英文参考文献.docVIP

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Updating the evidence for the role of corticosteroids in severe sepsis and septic shock a Bayesian meta-analytic perspective 英文参考文献.doc

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Updating the evidence for the role of corticosteroids in severe sepsis and septic shock a Bayesian meta-analytic perspective 英文参考文献

Moranetal.CriticalCare2010,14:R134 /content/14/4/R134 RESEARCH OpenAccess Updatingtheevidencefortheroleof corticosteroidsinseveresepsisandsepticshock: aBayesianmeta-analyticperspective JohnLMoran1*,PetraLGraham2,SueRockliff3,AndrewDBersten4 Abstract Introduction:Currentlow(stress)dosecorticosteroidregimensmayhavetherapeuticadvantageinseveresepsis andsepticshockdespiteconflictingresultsfromtwolandmarkrandomisedcontrolledtrials(RCT).We systematicallyreviewedtheefficacyofcorticosteroidtherapyinseveresepsisandsepticshock. Methods:RCTswereidentified(1950-September2008)bymultipledata-baseelectronicsearch(MEDLINEviaOVID, OVIDPreMedline,OVIDEmbase,CochraneCentralRegisterofControlledtrials,Cochranedatabaseofsystematic reviews,HealthTechnologyAssessmentDatabaseandDatabaseofAbstractsofReviewsofEffects)andhandsearch ofreferences,reviewsandscientificsocietyproceedings.Threeinvestigatorsindependentlyassessedtrialinclusion anddataextractionintostandardisedforms;differencesresolvedbyconsensus. Results:Corticosteroidefficacy,comparedwithcontrol,forhospital-mortality,proportionofpatientsexperiencing shock-resolution,andinfectiveandnon-infectivecomplicationswasassessedusingBayesianrandom-effects models;expressedasoddsratio(OR,(95%credible-interval)).Bayesianoutcomeprobabilitieswerecalculatedasthe probability(P)thatOR≥1.FourteenRCTswereidentified.High-dose(1000mghydrocortisone(equivalent)per day)corticosteroidtrialswereassociatedwithanull(n=5;OR0.91(0.31-1.25))orhigher(n=4,OR1.46(0.73-2.16), outlierexcluded)mortalityprobability(P=42.0%and89.3%,respectively).Low-dosetrials(1000mg hydrocortisoneperday)wereassociatedwithalower(n=9,OR0.80(0.40-1.39);n=8OR0.71(0.37-1.10),outlier excluded)mortalityprobability(20.4%and5.8%,respectively).ORforshock-resolutionwasincreasedinthelow dosetrials(n=7;OR1.20(1.07-4.55);P=98.2%).Patientresponsivenesstocorticotrophinstimulationwasnon- determinant.Ahighprobabilityofrisk-relatedtreatmentefficacy(decreaseinlog-oddsmortalitywithincreased controlarmrisk)wa