{"doi":"10.1177/1024907919833205","title":"Effects and safety of separate low-dose hydrocortisone use in patients with septic shock: A meta-analysis","abstract":"<jats:sec><jats:title>Objective:</jats:title><jats:p> The aim of this study was to explore the effects and safety of low-dose hydrocortisone in patients with septic shock. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> The PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched from database inception until 1 August 2018. Two reviewers performed literature selection, data extraction, and quality evaluation independently. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Twelve randomized controlled trials were included in this meta-analysis. The combined results showed that low-dose hydrocortisone use had no survival benefit in patients with septic shock (relative risk = 1.09; 95% confidence interval = 0.88–1.05; P = 0.37). But low-dose hydrocortisone use was useful for shock reverse (relative risk = 1.09; 95% confidence interval = 1.00–1.19; P = 0.04) and in shortening the time of vasopressor support (weighted mean difference = −1.79, 95% confidence interval = −2.05 to −1.52; P &lt; 0.00001). In addition, use of low-dose hydrocortisone was associated with a higher risk of hyperglycemia (relative risk = 1.21; 95% confidence interval = 1.04–1.40; P = 0.01) and hypernatremia (relative risk = 6.34; 95% confidence interval = 1.19–33.81; P = 0.03). There was no significant improvement of intensive care unit mortality (relative risk = 1.11; 95% confidence interval = 0.93–1.33; P = 0.23) or hospital mortality (relative risk = 1.08; 95% confidence interval = 0.94–1.24; P = 0.29), length of intensive care unit (weighted mean difference = −1.84; 95% confidence interval = −5.80 to 2.11; P = 0.36) or length of hospital (weighted mean difference = 0.11; 95% confidence interval = −2.06 to 2.29; P = 0.98), and time of mechanical support (weighted mean difference = −0.69; 95% confidence interval = −1.76 to −0.38; P = 0.20) with the use of low-dose hydrocortisone. There was no significant difference in secondary infection (relative risk = 1.04; 95% confidence interval = 0.91–1.18; P = 0.57), recurrence of shock (relative risk = 1.47; 95% confidence interval = 0.64–3.39; P = 0.36), and gastrointestinal bleeding (relative risk = 1.41; 95% confidence interval = 0.89–2.22; P = 0.14) with the use of low-dose hydrocortisone. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> Although there was no effect of low-dose hydrocortisone on survival of patients with septic shock, it is associated with a higher rate of shock reversal and shortening duration of vasopressor support; thus, low-dose hydrocortisone may be an alternative drug in septic shock patients who are refractory to fluid resuscitation and vasopressors. </jats:p></jats:sec>","journal":"Hong Kong Journal of Emergency Medicine","year":2020,"id":40394,"datarank":0.2135047352857864,"base_score":1.0986122886681096,"endowment":1.0986122886681096,"self_citation_contribution":0.16479184330021646,"citation_network_contribution":0.04871289198556995,"self_endowment_contribution":0.16479184330021646,"citer_contribution":0.04871289198556995,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":2,"citers_with_citation_signal":2,"citers_with_endowment":2,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":196364,"name":"Man Huang","orcid":null,"position":1,"is_corresponding":false},{"id":196365,"name":"QianWen Wang","orcid":null,"position":2,"is_corresponding":false},{"id":196366,"name":"Yuefeng Ma","orcid":null,"position":3,"is_corresponding":false},{"id":196367,"name":"Libing Jiang","orcid":null,"position":4,"is_corresponding":false},{"id":183972,"name":"Jing Wu","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"base_score":1.0986122886681096,"endowment":1.0986122886681096,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"18998881","pmcid":null,"openalex_id":"https://openalex.org/W2939697310","authors":[],"funders":[],"total_grants":0,"fwci":0.1597,"citation_percentile":0.53094979,"influential_citations":0,"citation_trend":[{"year":2021,"count":1},{"year":2026,"count":1}],"oa_status":"gold","license":"cc-by-nc","oa_locations":[{"url":"https://journals.sagepub.com/doi/pdf/10.1177/1024907919833205","host_type":"journal"},{"url":"https://journals.sagepub.com/doi/pdf/10.1177/1024907919833205","host_type":"GOLD"},{"url":"https://journals.sagepub.com/doi/pdf/10.1177/1024907919833205","host_type":"publisher"},{"url":"http://journals.sagepub.com/doi/pdf/10.1177/1024907919833205","host_type":"publisher"},{"url":"http://journals.sagepub.com/doi/full-xml/10.1177/1024907919833205","host_type":"publisher"},{"url":"https://doi.org/10.1177/1024907919833205","host_type":"journal"}],"fields_of_study":["Sepsis Diagnosis and Treatment","Adrenal Hormones and Disorders","Clinical Reasoning and Diagnostic Skills","Medicine"],"mesh_terms":[],"keywords":["Confidence interval","Relative risk","Medicine","Septic shock","Intensive care unit","Meta-analysis","Randomized controlled trial","Internal medicine","Cochrane Library","Anesthesia","Sepsis"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-06-12T05:33:36.767306Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}