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

Ethan Butler, Morten Hylander Møller, Oliver Cook, Anders Granholm, James Penketh, Sofie Louise Rygård, Anders Aneman, Anders Perner*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

8 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1540-1549
Number of pages10
JournalIntensive Care Medicine
Volume45
Issue number11
DOIs
Publication statusPublished - 1 Nov 2019
Externally publishedYes

Keywords

  • Corticosteroids
  • Critical illness
  • Gastrointestinal bleeding
  • Intensive care unit
  • Peptic ulcer disease
  • Steroids
  • Systematic review

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