Dose Effects of Steroids on Survival in Sepsis
Authors: Katherine J. Deans, Charles Natanson, Peter C. Minneci
Journal: Annals of Internal Medicine (2004)

Letters7 December 2004Dose Effects of Steroids on Survival in SepsisKatherine J. Deans, MD, Charles Natanson, MD, and Peter C. Minneci, MDKatherine J. Deans, MDFrom National Institutes of Health, Bethesda, MD 20892.Search for more papers by this author, Charles Natanson, MDFrom National Institutes of Health, Bethesda, MD 20892.Search for more papers by this author, and Peter C. Minneci, MDFrom National Institutes of Health, Bethesda, MD 20892.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-11-200412070-00027 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Drs. Noble and Badgett raise important concerns about the findings of our meta-analysis. In response to Dr. Noble, a properly performed meta-analysis is similar to a clinical trial in that they are both prospective studies with inclusion criteria, end points, and analytic strategies defined before the beginning of the study. Furthermore, in a meta-analysis with significant heterogeneity, it is essential to partition the data set into homogeneous groups to explain the heterogeneity of the data (1). This is not considered an analysis of multiple comparisons but rather a fundamental technique of meta-analysis. In our study, the significantly heterogeneous ...References1. Thompson SG. Why sources of heterogeneity in meta-analysis should be investigated. BMJ. 1994;309:1351-5. [PMID: 7866085] CrossrefMedlineGoogle Scholar2. 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 Scholar3. 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 Scholar4. Annane D, Bellissant E, Bollaert PE, Briegel J, Keh D, Kupfer Y. Corticosteroids for severe sepsis and septic shock: a systematic review and meta-analysis. BMJ. 2004;329:480. [PMID: 15289273] CrossrefMedlineGoogle Scholar5. Hamrahian AH, Oseni TS, Arafah BM. Measurements of serum free cortisol in critically ill patients. N Engl J Med. 2004;350:1629-38. [PMID: 15084695] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From National Institutes of Health, Bethesda, MD 20892. 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 David W. Noble Dose Effects of Steroids on Survival in Sepsis Robert G. Badgett Metrics 7 December 2004Volume 141, Issue 11Page: 892KeywordsAdrenocorticotropic hormoneAdverse eventsClinical trialsCortisolMortalityProspective studiesSepsisShockSteroid therapySteroids ePublished: 7 December 2004 Issue Published: 7 December 2004 CopyrightCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...