Dose Effects of Steroids on Survival in Sepsis
Authors: David W. Noble
Journal: Annals of Internal Medicine (2004)

Letters7 December 2004Dose Effects of Steroids on Survival in SepsisDavid W. Noble, BMedBiol, MBChB, FRCADavid W. Noble, BMedBiol, MBChB, FRCAFrom Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, Scotland, United Kingdom.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-11-200412070-00025 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The meta-analysis by Minneci and colleagues (1) on steroids for septic shock was interpreted too narrowly and may provide a misleading picture for practicing intensivists. I have 3 areas of concern.First, the data analysis was retrospective, exploratory, and uncorrected for multiple comparisons (2). Should the conclusions, then, have been less definitive than those actually offered?Second, Minneci and colleagues excluded the low-dose steroid study by Bennett and coworkers (3) from their low-dose steroid analysis. Although they provided a rationale for this exclusion, the study by Bennett and coworkers remained the second largest study in this analysis ...References1. Minneci PC, Deans KJ, Banks SM, Eichacker PQ, Natanson C. Meta-analysis: the effect of steroids on survival and shock during sepsis depends on the dose. Ann Intern Med. 2004;141:47-56. [PMID: 15238370] LinkGoogle Scholar2. Pogue J, Yusuf S. Overcoming the limitations of current meta-analysis of randomised controlled trials. Lancet. 1998;351:47-52. [PMID: 9433436] CrossrefMedlineGoogle Scholar3. Bennett IL, Finland M, Hamburger M, Kass EH, Lepper M, Waisbren BA. The effectiveness of hydrocortisone in the management of severe infection. JAMA. 1963;183:462-5. CrossrefGoogle Scholar4. Annane D, Sébille V, Charpentier C, Bollaert PE, François B, Korach JM, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002;288:862-71. [PMID: 12186604] CrossrefMedlineGoogle Scholar5. Bloomfield R, Noble DW. Corticosteroids for septic shock—a standard of care? [Editorial]. Br J Anaesth. 2004;93:178-80. [PMID: 15251993] CrossrefMedlineGoogle Scholar6. Eysenck HJ. Meta-analysis and its problems. BMJ. 1994;309:789-92. [PMID: 7950571] CrossrefMedlineGoogle Scholar7. Luce JM. Physicians should administer low-dose corticosteroids selectively to septic patients until an ongoing trial is completed [Editorial]. Ann Intern Med. 2004;141:70-2. [PMID: 15238374] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, Scotland, United Kingdom. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMeta-Analysis: The Effect of Steroids on Survival and Shock during Sepsis Depends on the Dose Peter C. Minneci , Katherine J. Deans , Steven M. Banks , Peter Q. Eichacker , and Charles Natanson Physicians Should Administer Low-Dose Corticosteroids Selectively to Septic Patients until an Ongoing Trial Is Completed John M. Luce Dose Effects of Steroids on Survival in Sepsis Robert G. Badgett Dose Effects of Steroids on Survival in Sepsis Katherine J. Deans , Charles Natanson , and Peter C. Minneci Metrics Cited ByAdrenal Insufficiency in Critical Illness 7 December 2004Volume 141, Issue 11Page: 891KeywordsAdrenalectomyAdrenocorticotropic hormoneDecision makingExerciseSepsisShockSteroids ePublished: 7 December 2004 Issue Published: 7 December 2004 CopyrightCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...