Cochrane Database Syst Rev

Corticosteroids likely reduce short-term mortality in sepsis

June 11, 2025

Moderate-certainty evidence supports corticosteroids as a therapy that probably reduces short-term and in-hospital mortality in sepsis, with possible reductions in ICU and hospital length of stay. Adverse effects, particularly muscle weakness, remain uncertain, and optimal administration strategies aren't established.

Study details: This updated Cochrane systematic review included 87 randomized trials (24,336 participants; adults and children) comparing corticosteroids against placebo or usual care in sepsis. The primary outcome was 28-day all-cause mortality, with secondary outcomes including long-term and in-hospital mortality, ICU/hospital length of stay, and adverse effects (superinfection, muscle weakness).

Results: Corticosteroids probably reduce 28-day mortality (risk ratio [RR], 0.89; 95% confidence interval [CI], 0.84–0.95; moderate-certainty evidence) and in-hospital mortality (RR, 0.90; 95% CI, 0.84–0.97; moderate-certainty). There may be little to no effect on long-term mortality. Corticosteroids may shorten ICU (mean difference [MD], -0.86 days) and hospital stay (MD, -1.09 days), but evidence is of low certainty. The risk of superinfection is likely unchanged, while the effect on muscle weakness remains uncertain. The effects of continuous infusion vs. intermittent bolus corticosteroid administration are uncertain due to very low-certainty evidence.

Source:

Annane D, et al. (2025, June 5). Cochrane Database Syst Rev. Corticosteroids for treating sepsis in children and adults. https://pubmed.ncbi.nlm.nih.gov/40470636/