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In 2018, two trials on whether steroids benefitted septic shock patients yielded disparate results (NEJM JW Gen Med Jan 1 2019 and N Engl J Med 2018; 378:797, 809). Because previous systematic reviews and meta-analyses also have generated conflicting interpretations, investigators hoped that adding data on more than 5000 patients from these two trials would provide a clearer picture.
In this new meta-analysis, 37 randomized trials that involved nearly 10,000 septic patients were identified; 18 trials included patients with septic shock. Most trials involved relatively low-dose corticosteroids (e.g., 200-mg hydrocortisone daily), but formulations and dosing strategies varied greatly. All-cause 28-day mortality was significantly lower in patie…