• Waleed Tharwat Aletreby, Abdulrahman Mishaal Alharthy, Ahmed Fouad Madi, Ibrahim Refaat Soliman, Hend Mohammed Hamido, Omar Elsayed Ramadan, Wasim Alzayer, Basim Mohammed Huwait, Mohammed Ali Alodat, Shahzad Ahmed Mumtaz, Nasir Nasim Mahmood, Mahmoud Hussien Al Kurdi, Hazem Abdulgaffar Farrag, and Dimitrios Karakitsos.
• Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia.
• Arch Iran Med. 2019 Jul 1; 22 (7): 394-402.

BackgroundSepsis and septic shock are major causes of morbidity and mortality worldwide, associated with a high economic and social burden on healthcare systems and communities, yet with few definite treatment modalities. The efficacy of steroids in the management of sepsis or septic shock remains a controversy and subject of investigation due to their theoretical beneficial effects.MethodsThis was a systematic literature review and meta-analysis on randomized controlled trials of hydrocortisone usage in sepsis or septic shock as of 2000, following the GRADE methodology, considering a primary outcome of 28 day all-cause mortality.ResultsTen randomized control trials were included in the review, 9 of which reported 28 day mortality either as a primary or secondary outcome. Relative risk of dying at 28 days was 0.93 in favor of hydrocortisone (95% CI: 0.86-1.01; P = 0.056). Other secondary outcomes of the review were similarly statistically insignificant. The quality of evidence was graded as very low to low.ConclusionHydrocortisone, when used in sepsis or septic shock, in critically ill adult patients showed a statistically insignificant trend towards decreasing 28 day all-cause mortality. This warrants consideration of clinical significance for each patient individually.© 2019 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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