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Early goal-directed therapy reduces mortality in adult patients with severe sepsis and septic shock: Systematic review and meta-analysis.

Chelkeba L, Ahmadi A, Abdollahi M, Najafi A, Mojtahedzadeh M - Indian J Crit Care Med (2015)

Bottom Line: We included RCTs that compared EGDT with usual care in our meta-analysis.We found that EGDT significantly reduced mortality in a random-effect model (RR, 0.86; 95% confidence interval [CI], 0.72-0.94; P = 0.008;   I (2) =50%).Paradoxically, EGDT increased the length of hospital stay compared to usual routine care.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy, International campus (TUMS-IC), Tehran, Iran ; Department of Anesthesiology and Critical Care Medicine, Sina Hospital, Faculty of Medicine, Tehran, Iran ; Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran ; Department of clinical Pharmacy, Colleague of Public health and Medical Sciences, Jimma University, Jimma, Ethiopia.

ABSTRACT

Introduction: Survival sepsis campaign guidelines have promoted early goal-directed therapy (EGDT) as a means for reduction of mortality. On the other hand, there were conflicting results coming out of recently published meta-analyses on mortality benefits of EGDT in patients with severe sepsis and septic shock. On top of that, the findings of three recently done randomized clinical trials (RCTs) showed no survival benefit by employing EGDT compared to usual care. Therefore, we aimed to do a meta-analysis to evaluate the effect of EGDT on mortality in severe sepsis and septic shock patients.

Methodology: We included RCTs that compared EGDT with usual care in our meta-analysis. We searched in Hinari, PubMed, EMBASE, and Cochrane central register of controlled trials electronic databases and other articles manually from lists of references of extracted articles. Our primary end point was overall mortality.

Results: A total of nine trails comprising 4783 patients included in our analysis. We found that EGDT significantly reduced mortality in a random-effect model (RR, 0.86; 95% confidence interval [CI], 0.72-0.94; P = 0.008;   I (2) =50%). We also did subgroup analysis stratifying the studies by the socioeconomic status of the country where studies were conducted, risk of bias, the number of sites where the trials were conducted, setting of trials, publication year, and sample size. Accordingly, trials carried out in low to middle economic income countries (RR, 0.078; 95% CI, 0.67-0.91; P = 0.002; I (2) = 34%) significantly reduced mortality compared to those in higher income countries (RR, 0.93; 95% CI, 0.33-1.06; P = 0.28; I(2) = 29%). On the other hand, patients receiving EGDT had longer length of hospital stay compared to the usual care (mean difference, 0.49; 95% CI, -0.04-1.02; P = 0.07; I (2) = 0%).

Conclusion: The result of our study showed that EGDT significantly reduced mortality in patients with severe sepsis and septic shock. Paradoxically, EGDT increased the length of hospital stay compared to usual routine care.

No MeSH data available.


Related in: MedlinePlus

Forest plot of overall mortality. The study was stratified by number of sites, publication year. Risk ratio (RR) <1 favors EGDT. CI = confidence interval; M-H = Mantel-Haenszel
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Figure 6: Forest plot of overall mortality. The study was stratified by number of sites, publication year. Risk ratio (RR) <1 favors EGDT. CI = confidence interval; M-H = Mantel-Haenszel

Mentions: Mortality data were available in all nine[61112131620212223] studies included in the meta-analysis. The results of this study showed that the overall mortality rate in EGDT and usual care groups was 712 (29.7%) of 2384 and 812 (33.8%) of 2403, respectively, an absolute 4.1% (100 patients) risk reduction. Hence, EGDT significantly reduced overall mortality in the random-effect model (RR, 0.86; 95% CI, 0.76–0.96; P = 0.008; I2 = 50%) as shown in Figure 3. We also did preplanned subgroup analysis stratifying patients by the socioeconomic status of countries, the risk of bias, setting, sites of study, year of publication, and sample size. Accordingly, we found that studies carried out in low to middle income countries had lower overall mortality rate in random-effect model (RR, 0.78; 95% CI, 0.67–0.91; P = 0.0.002; I2 = 34%) compared to those studies in higher income countries (RR, 0.93; 95% CI, 0.83−1.06; P = 0.28; I2 = 29%) Figures 3–6. The result of other subgroups was displayed in Table 2.


Early goal-directed therapy reduces mortality in adult patients with severe sepsis and septic shock: Systematic review and meta-analysis.

Chelkeba L, Ahmadi A, Abdollahi M, Najafi A, Mojtahedzadeh M - Indian J Crit Care Med (2015)

Forest plot of overall mortality. The study was stratified by number of sites, publication year. Risk ratio (RR) <1 favors EGDT. CI = confidence interval; M-H = Mantel-Haenszel
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4502493&req=5

Figure 6: Forest plot of overall mortality. The study was stratified by number of sites, publication year. Risk ratio (RR) <1 favors EGDT. CI = confidence interval; M-H = Mantel-Haenszel
Mentions: Mortality data were available in all nine[61112131620212223] studies included in the meta-analysis. The results of this study showed that the overall mortality rate in EGDT and usual care groups was 712 (29.7%) of 2384 and 812 (33.8%) of 2403, respectively, an absolute 4.1% (100 patients) risk reduction. Hence, EGDT significantly reduced overall mortality in the random-effect model (RR, 0.86; 95% CI, 0.76–0.96; P = 0.008; I2 = 50%) as shown in Figure 3. We also did preplanned subgroup analysis stratifying patients by the socioeconomic status of countries, the risk of bias, setting, sites of study, year of publication, and sample size. Accordingly, we found that studies carried out in low to middle income countries had lower overall mortality rate in random-effect model (RR, 0.78; 95% CI, 0.67–0.91; P = 0.0.002; I2 = 34%) compared to those studies in higher income countries (RR, 0.93; 95% CI, 0.83−1.06; P = 0.28; I2 = 29%) Figures 3–6. The result of other subgroups was displayed in Table 2.

Bottom Line: We included RCTs that compared EGDT with usual care in our meta-analysis.We found that EGDT significantly reduced mortality in a random-effect model (RR, 0.86; 95% confidence interval [CI], 0.72-0.94; P = 0.008;   I (2) =50%).Paradoxically, EGDT increased the length of hospital stay compared to usual routine care.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy, International campus (TUMS-IC), Tehran, Iran ; Department of Anesthesiology and Critical Care Medicine, Sina Hospital, Faculty of Medicine, Tehran, Iran ; Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran ; Department of clinical Pharmacy, Colleague of Public health and Medical Sciences, Jimma University, Jimma, Ethiopia.

ABSTRACT

Introduction: Survival sepsis campaign guidelines have promoted early goal-directed therapy (EGDT) as a means for reduction of mortality. On the other hand, there were conflicting results coming out of recently published meta-analyses on mortality benefits of EGDT in patients with severe sepsis and septic shock. On top of that, the findings of three recently done randomized clinical trials (RCTs) showed no survival benefit by employing EGDT compared to usual care. Therefore, we aimed to do a meta-analysis to evaluate the effect of EGDT on mortality in severe sepsis and septic shock patients.

Methodology: We included RCTs that compared EGDT with usual care in our meta-analysis. We searched in Hinari, PubMed, EMBASE, and Cochrane central register of controlled trials electronic databases and other articles manually from lists of references of extracted articles. Our primary end point was overall mortality.

Results: A total of nine trails comprising 4783 patients included in our analysis. We found that EGDT significantly reduced mortality in a random-effect model (RR, 0.86; 95% confidence interval [CI], 0.72-0.94; P = 0.008;   I (2) =50%). We also did subgroup analysis stratifying the studies by the socioeconomic status of the country where studies were conducted, risk of bias, the number of sites where the trials were conducted, setting of trials, publication year, and sample size. Accordingly, trials carried out in low to middle economic income countries (RR, 0.078; 95% CI, 0.67-0.91; P = 0.002; I (2) = 34%) significantly reduced mortality compared to those in higher income countries (RR, 0.93; 95% CI, 0.33-1.06; P = 0.28; I(2) = 29%). On the other hand, patients receiving EGDT had longer length of hospital stay compared to the usual care (mean difference, 0.49; 95% CI, -0.04-1.02; P = 0.07; I (2) = 0%).

Conclusion: The result of our study showed that EGDT significantly reduced mortality in patients with severe sepsis and septic shock. Paradoxically, EGDT increased the length of hospital stay compared to usual routine care.

No MeSH data available.


Related in: MedlinePlus