文献类型：期刊文献

英文题名：Controversies in the application of corticosteroids for pediatric septic shock treatment: a preferred reporting items for systematic reviews and meta-analysis-compliant updated meta-analysis

作者：Yang, Jing[1];Sun, Shaobo[2]

第一作者：Yang, Jing

通信作者：Yang, J[1]

机构：[1]Lanzhou Univ, Hosp 2, Dept Pediat Respirat, Lanzhou, Gansu, Peoples R China;[2]Gansu Univ Chinese Med, Coll Pharm, Lanzhou, Gansu, Peoples R China

第一机构：Lanzhou Univ, Hosp 2, Dept Pediat Respirat, Lanzhou, Gansu, Peoples R China

通信机构：[1]corresponding author), 80 Cuiyingmen, Lanzhou 730000, Gansu, Peoples R China.

年份：2020

卷号：99

期号：30

起止页码：e20762

外文期刊名：MEDICINE

收录：;Scopus(收录号：2-s2.0-85089475357);WOS:【SCI-EXPANDED(收录号:WOS:000558420900013)】；

语种：英文

外文关键词：corticosteroids; meta-analysis; pediatric; septic shock; systematic review

摘要：Objectives: Septic shock is the major cause of childhood mortality. However, the application of corticosteroids remains controversial. This work aimed to analyze the source of controversy based on existing data and recent randomized controlled trials by meta-analysis and to assess whether it can avoid these factors to guide clinical treatment. Methods: We searched the public databases up to 8 June 2019 and included only randomized controlled trials. The primary outcome was mortality. Sensitivity analysis, subgroup analysis, and dose-response meta-analysis were performed in this work. Results: We included twelve studies consisting of 701 children in the meta-analysis. For primary outcome, the fixed-effect model showed steroids could significantly reduce the mortality compared to the control (Odds Ratio: 0.67; 95% confidence interval: 0.46-0.98;P = .041). However, the random-effect model showed a negative result (Odds Ratio: 0.69; 95% confidence interval: 0.32-1.51;P = .252). None of the subgroup results rejected the null hypothesis that the overall effect equaled zero. Dose-response effect analysis showed that increased dosage at a low dosage might reduce the mortality, while at a high dosage, increasing the dose might increase the mortality. Moreover, the grading of recommendations assessment, development, and evaluation level of evidence is low for mortality. Conclusions: Corticosteroid application is not recommended for septic shock children under current medical conditions.