Effect of Combined Hydrocortisone, Ascorbic Acid and Thiamine for Patients with Sepsis and Septic Shock: A Systematic Review and Meta-Analysis
Effect of Combined Hydrocortisone, Ascorbic Acid and Thiamine for Patients with Sepsis and Septic Shock: A Systematic Review and Meta-Analysis
复制标题
氢化可的松、抗坏血酸和硫胺素联合治疗脓毒症和感染性休克患者的效果：系统评价和荟萃分析
作者：
Tong Wu;Chang Hu;Wei;Qiancheng Xu;Bo Hu;Jianguo Li
摘要目的：本研究旨在评价HAT治疗脓毒症及感染性休克的疗效。方法：我们检索PubMed、Embase和Cochrane图书馆，检索截至2020年11月11日发表的HAT治疗研究。主要终点是血管加压剂使用的持续时间。次要结局为72 h内序贯器官衰竭（SOFA）评分的变化；在重症监护病房（ICU）、医院内死亡，28天或30天；在ICU和医院的住院时间；降钙素原（PCT）清除率和不良事件发生率。我们还使用试验序列分析（TSA）来评估现有证据的可靠性。结果：纳入6项随机对照试验（rct）和7项观察性研究，共纳入1559例患者（762例接受HAT治疗，797例单独接受氢化可的松、标准治疗或安慰剂治疗）。在随机对照试验中，HAT治疗与血管加压剂使用时间的显著缩短相关（平均差异[MD]， - 14.68, [95% CI, - 24.28至- 5.08],P = 0.003），但在观察性研究中无相关（MD, 11.21 [95% CI, - 44.93至67.35],P = 0.70）。在随机对照试验（MD, - 0.86 [95% CI, - 1.32至- 0.40],P < 0.001）和观察性研究（MD, - 2.65 [95% CI, - 5.29至- 0.01],P = 0.05）中，HAT治疗与72小时器官功能障碍减少相关。在观察性研究中，HAT治疗与较低的住院死亡率和较高的PCT清除率相关。在敏感性分析中发现了主要结局的类似结果。运输安全管理局的结果建议进行更多的试验以达到所需的信息量。结论：在脓毒症和感染性休克患者中，与安慰剂相比，氢化可的松、抗坏血酸和硫胺素联合治疗可减少前72小时血管加压剂的使用时间和SOFA评分。试验注册：本次研究的PROSPERO注册ID为CRD42020170648 （https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=170648）。
Supplemental Digital Content is available in the text ABSTRACT Objective: This study aims to assess the effect of HAT therapy on patients with sepsis and septic shock. Methods: We searched PubMed, Embase, and Cochrane Library for studies on HAT therapy published up to November 11, 2020. The primary outcome was the duration of vasopressor use. Secondary outcomes were change of Sequential Organ Failure Assessment (SOFA) score within 72 h; death within intensive care unit (ICU), hospital, and 28 or 30 days; length of stay in ICU and hospital; rate of procalcitonin (PCT) clearance and incidence of adverse events. We also used trial sequential analysis (TSA) to assess the reliability of the available evidence. Results: Six randomized controlled trials (RCTs) and seven observational studies enrolling 1,559 patients were included (762 were treated with HAT, and 797 were treated with hydrocortisone alone, standard care or placebo). HAT therapy was associated with significant reductions in duration of vasopressor use (mean differences [MD], −14.68, [95% CI, −24.28 to −5.08], P = 0.003) in RCTs, but not in observational studies (MD, 11.21 [95% CI, −44.93 to 67.35], P = 0.70). HAT therapy was associated with less organ dysfunction at 72 h both in RCTs (MD, −0.86 [95% CI, −1.32 to −0.40], P < 0.001) and observational studies (MD, −2.65 [95% CI, −5.29 to −0.01], P = 0.05). HAT therapy was associated with lower hospital mortality and higher PCT clearance in observational studies. Similar results for the primary outcome were found in the sensitivity analysis. TSA results suggested more trials to reach the required information size. Conclusion: Among patients with sepsis and septic shock, a combination therapy of hydrocortisone, ascorbic acid, and thiamine, compared with placebo, could reduce the duration of vasopressor use and SOFA scores during the first 72 h. Trial registration: PROSPERO registration ID for this study is CRD42020170648 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=170648).
影响因子：
120.7
作者：
Fowler, Alpha A., III;Truwit, Jonathon D.;Halquist, Matthew
通讯作者：
Halquist, Matthew
影响因子：
120.7
作者：
Moskowitz, Ari;Huang, David T.;Donnino, Michael W.
通讯作者：
Donnino, Michael W.
DOI：
10.1001/jama.2016.0289
发表时间：
2016-02-23
期刊：
JAMA
影响因子：
--
作者：
Shankar-Hari M;Phillips GS;Levy ML;Seymour CW;Liu VX;Deutschman CS;Angus DC;Rubenfeld GD;Singer M;Sepsis Definitions Task Force
通讯作者：
Sepsis Definitions Task Force