Abstract
BACKGROUND: This study aimed to assess the impact of the timing of low-dose hydrocortisone adjuvant therapy initiation on clinical outcomes in patients with septic shock by a systematic review and meta-analysis. METHODS: We conducted a comprehensive search of all randomized controlled trials (RCTs) and cohort studies available in the PubMed, Web of Science, and Embase databases. The search included articles published from the founding of these databases until August 1, 2024. The purpose of the search was to compare the results of initiating low-dose hydrocortisone (HC) adjuvant therapy at different time periods. The main reported results included short-term mortality (ICU mortality and hospital mortality) as key outcomes, and secondary outcomes such as the rate of renal replacement treatment continuous renal replacement therapy (CRRT), length of stay in the intensive care unit (ICU), and rate of shock reversal. RESULTS: Seven trials, with a total of 3063 patients, were included. The main finding of this meta-analysis indicates that the early treatment group, which received low-dose hydrocortisone, had a lower ICU mortality rate compared to the late treatment group. Additionally, the hospital mortality rate in the early treatment group was lower than that in the late treatment group. There was a correlation between the timing of beginning of HC and the short-term mortality of patients with septic shock. The secondary findings indicated that there were no notable disparities in the rates of CRRT, the rate of reversing shock, and the duration of stay in the ICU. CONCLUSION: Administering low doses of HC early on can decrease the risk of death in septic shock patients in the short-term mortality. There were no substantial disparities observed in the rate of CRRT, the rate of reversal of shock, and the duration of stay in the ICU. Additional extensive RCTs are required to validate this conclusion.