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The effect of systemic corticosteroids on the incidence of gastrointestinal bleeding in critically ill adults: a systematic review with meta-analysis

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@article{4375da24161e4f8fbf3752bcd1a7db2f,
title = "The effect of systemic corticosteroids on the incidence of gastrointestinal bleeding in critically ill adults: a systematic review with meta-analysis",
abstract = "PURPOSE: To assess the effect of systemic corticosteroids on the incidence of gastrointestinal bleeding in adult critically ill patients.METHODS: We systematically reviewed randomised clinical trials comparing systemic corticosteroids administered for more than 24 h with placebo/no treatment in adult critically ill patients. Trial selection, data abstraction and risk of bias assessments were performed in duplicate. We used trial sequential analysis (TSA) to assess the risk of random errors and the grading of recommendations, assessment, development, and evaluations (GRADE) approach to assess the quality of evidence. The primary outcome was the incidence of clinically important gastrointestinal bleeding within 90 days. The secondary outcome was the incidence of gastrointestinal bleeding of any severity within 90 days.RESULTS: Twenty-five trials (n = 14,615) reported data for the primary outcome and 55 trials (n = 21,792) for the secondary outcome. The pooled incidence of clinically important gastrointestinal bleeding was 2.3{\%} in the corticosteroid group and 1.8{\%} in the control group (RR, 1.26; 95{\%} CI, 1.01-1.57; I2 = 0{\%}, TSA-adjusted CI 0.51-3.14). We observed no difference in the risk of gastrointestinal bleeding of any severity (RR, 1.10; 95{\%} CI, 0.92-1.32; I2 = 0{\%}, TSA-adjusted CI 0.87-1.38). The GRADE quality of evidence was low (risk of bias and imprecision).CONCLUSIONS: We observed an overall low incidence of clinically important gastrointestinal bleeding among adult critically ill patients. Corticosteroids may slightly increase the incidence of clinically important gastrointestinal bleeding, but not bleeding of any severity. Rarity of events, infrequent trial reporting and high risk of bias reduced the quality of evidence.",
keywords = "Corticosteroids, Critical illness, Gastrointestinal bleeding, Intensive care unit, Peptic ulcer disease, Steroids, Systematic review",
author = "Ethan Butler and M{\o}ller, {Morten Hylander} and Oliver Cook and Anders Granholm and James Penketh and Ryg{\aa}rd, {Sofie Louise} and Anders Aneman and Anders Perner",
year = "2019",
month = "11",
doi = "10.1007/s00134-019-05754-3",
language = "English",
volume = "45",
pages = "1540--1549",
journal = "Intensive Care Medicine",
issn = "0342-4642",
publisher = "Springer",
number = "11",

}

RIS

TY - JOUR

T1 - The effect of systemic corticosteroids on the incidence of gastrointestinal bleeding in critically ill adults

T2 - a systematic review with meta-analysis

AU - Butler, Ethan

AU - Møller, Morten Hylander

AU - Cook, Oliver

AU - Granholm, Anders

AU - Penketh, James

AU - Rygård, Sofie Louise

AU - Aneman, Anders

AU - Perner, Anders

PY - 2019/11

Y1 - 2019/11

N2 - PURPOSE: To assess the effect of systemic corticosteroids on the incidence of gastrointestinal bleeding in adult critically ill patients.METHODS: We systematically reviewed randomised clinical trials comparing systemic corticosteroids administered for more than 24 h with placebo/no treatment in adult critically ill patients. Trial selection, data abstraction and risk of bias assessments were performed in duplicate. We used trial sequential analysis (TSA) to assess the risk of random errors and the grading of recommendations, assessment, development, and evaluations (GRADE) approach to assess the quality of evidence. The primary outcome was the incidence of clinically important gastrointestinal bleeding within 90 days. The secondary outcome was the incidence of gastrointestinal bleeding of any severity within 90 days.RESULTS: Twenty-five trials (n = 14,615) reported data for the primary outcome and 55 trials (n = 21,792) for the secondary outcome. The pooled incidence of clinically important gastrointestinal bleeding was 2.3% in the corticosteroid group and 1.8% in the control group (RR, 1.26; 95% CI, 1.01-1.57; I2 = 0%, TSA-adjusted CI 0.51-3.14). We observed no difference in the risk of gastrointestinal bleeding of any severity (RR, 1.10; 95% CI, 0.92-1.32; I2 = 0%, TSA-adjusted CI 0.87-1.38). The GRADE quality of evidence was low (risk of bias and imprecision).CONCLUSIONS: We observed an overall low incidence of clinically important gastrointestinal bleeding among adult critically ill patients. Corticosteroids may slightly increase the incidence of clinically important gastrointestinal bleeding, but not bleeding of any severity. Rarity of events, infrequent trial reporting and high risk of bias reduced the quality of evidence.

AB - PURPOSE: To assess the effect of systemic corticosteroids on the incidence of gastrointestinal bleeding in adult critically ill patients.METHODS: We systematically reviewed randomised clinical trials comparing systemic corticosteroids administered for more than 24 h with placebo/no treatment in adult critically ill patients. Trial selection, data abstraction and risk of bias assessments were performed in duplicate. We used trial sequential analysis (TSA) to assess the risk of random errors and the grading of recommendations, assessment, development, and evaluations (GRADE) approach to assess the quality of evidence. The primary outcome was the incidence of clinically important gastrointestinal bleeding within 90 days. The secondary outcome was the incidence of gastrointestinal bleeding of any severity within 90 days.RESULTS: Twenty-five trials (n = 14,615) reported data for the primary outcome and 55 trials (n = 21,792) for the secondary outcome. The pooled incidence of clinically important gastrointestinal bleeding was 2.3% in the corticosteroid group and 1.8% in the control group (RR, 1.26; 95% CI, 1.01-1.57; I2 = 0%, TSA-adjusted CI 0.51-3.14). We observed no difference in the risk of gastrointestinal bleeding of any severity (RR, 1.10; 95% CI, 0.92-1.32; I2 = 0%, TSA-adjusted CI 0.87-1.38). The GRADE quality of evidence was low (risk of bias and imprecision).CONCLUSIONS: We observed an overall low incidence of clinically important gastrointestinal bleeding among adult critically ill patients. Corticosteroids may slightly increase the incidence of clinically important gastrointestinal bleeding, but not bleeding of any severity. Rarity of events, infrequent trial reporting and high risk of bias reduced the quality of evidence.

KW - Corticosteroids

KW - Critical illness

KW - Gastrointestinal bleeding

KW - Intensive care unit

KW - Peptic ulcer disease

KW - Steroids

KW - Systematic review

UR - http://www.scopus.com/inward/record.url?scp=85074083263&partnerID=8YFLogxK

U2 - 10.1007/s00134-019-05754-3

DO - 10.1007/s00134-019-05754-3

M3 - Review

VL - 45

SP - 1540

EP - 1549

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

IS - 11

ER -

ID: 58598845