Adverse Effects Related to Corticosteroid Use in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis

Dipayan Chaudhuri, MD; Lori Israelian, MD; Zbigniew Putowski, MD; Jay Prakash, MBBS; Tyler Pitre, MD; Andrea M. Nei, PharmD; Joanna L. Spencer-Segal, MD, PhD; Hayley B. Gershengorn, MD; Djillali Annane, MD; Stephen M. Pastores, MD; Bram Rochwerg, MD

doi:10.1097/CCE.0000000000001071

Critical Care Explorations (Apr 2024)

Adverse Effects Related to Corticosteroid Use in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis

Dipayan Chaudhuri, MD,
Lori Israelian, MD,
Zbigniew Putowski, MD,
Jay Prakash, MBBS,
Tyler Pitre, MD,
Andrea M. Nei, PharmD,
Joanna L. Spencer-Segal, MD, PhD,
Hayley B. Gershengorn, MD,
Djillali Annane, MD,
Stephen M. Pastores, MD,
Bram Rochwerg, MD

Affiliations

Dipayan Chaudhuri, MD: 1 Department of Medicine, McMaster University, Hamilton, ON, Canada.
Lori Israelian, MD: 1 Department of Medicine, McMaster University, Hamilton, ON, Canada.
Zbigniew Putowski, MD: 2 Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
Jay Prakash, MBBS: 3 Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
Tyler Pitre, MD: 4 Department of Medicine, University of Toronto, Toronto, ON, Canada.
Andrea M. Nei, PharmD: 5 Department of Pharmacy, Mayo Clinic Hospital, Rochester, MN.
Joanna L. Spencer-Segal, MD, PhD: 6 Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI.
Hayley B. Gershengorn, MD: 8 Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL.
Djillali Annane, MD: 10 Department of Intensive Care, Hôpital Raymond Poincaré, FHU SEPSIS, AP-HP, Garches, France.
Stephen M. Pastores, MD: 12 Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
Bram Rochwerg, MD: 1 Department of Medicine, McMaster University, Hamilton, ON, Canada.

DOI: https://doi.org/10.1097/CCE.0000000000001071
Journal volume & issue: Vol. 6, no. 4
p. e1071

Abstract

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OBJECTIVES:. We postulate that corticosteroid-related side effects in critically ill patients are similar across sepsis, acute respiratory distress syndrome (ARDS), and community-acquired pneumonia (CAP). By pooling data across all trials that have examined corticosteroids in these three acute conditions, we aim to examine the side effects of corticosteroid use in critical illness. DATA SOURCES:. We performed a comprehensive search of MEDLINE, Embase, Centers for Disease Control and Prevention library of COVID research, CINAHL, and Cochrane center for trials. STUDY SELECTION:. We included randomized controlled trials (RCTs) that compared corticosteroids to no corticosteroids or placebo in patients with sepsis, ARDS, and CAP. DATA EXTRACTION:. We summarized data addressing the most described side effects of corticosteroid use in critical care: gastrointestinal bleeding, hyperglycemia, hypernatremia, superinfections/secondary infections, neuropsychiatric effects, and neuromuscular weakness. DATA SYNTHESIS:. We included 47 RCTs (n = 13,893 patients). Corticosteroids probably have no effect on gastrointestinal bleeding (relative risk [RR], 1.08; 95% CI, 0.87–1.34; absolute risk increase [ARI], 0.3%; moderate certainty) or secondary infections (RR, 0.97; 95% CI, 0.89–1.05; absolute risk reduction, 0.5%; moderate certainty) and may have no effect on neuromuscular weakness (RR, 1.22; 95% CI, 1.03–1.45; ARI, 1.4%; low certainty) or neuropsychiatric events (RR, 1.19; 95% CI, 0.82–1.74; ARI, 0.5%; low certainty). Conversely, they increase the risk of hyperglycemia (RR, 1.21; 95% CI, 1.11–1.31; ARI, 5.4%; high certainty) and probably increase the risk of hypernatremia (RR, 1.59; 95% CI, 1.29–1.96; ARI, 2.3%; moderate certainty). CONCLUSIONS:. In ARDS, sepsis, and CAP, corticosteroids are associated with hyperglycemia and probably with hypernatremia but likely have no effect on gastrointestinal bleeding or secondary infections. More data examining effects of corticosteroids, particularly on neuropsychiatric outcomes and neuromuscular weakness, would clarify the safety of this class of drugs in critical illness.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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