Clinical Outcomes of Early Goal-Directed Therapy vs Usual Care for Patients With Early Septic Shock: A Meta-analysis of Randomized Controlled Trials

Abstract

SESSION TITLE: Sepsis and Shock Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: Early goal-directed therapy (EGDT) has been endorsed as a key therapeutic strategy in the management of early septic shock aiming to improve survival and reduce length of hospitalization. However; evidence is conflicting regarding the efficacy of EGDT compared to usual care. METHODS: A systematic literature review identified publications of randomized controlled trials (RCT) evaluating EGDT in early septic shock were used to obtain data. Odds ratios (OR) and 95% confidence intervals (CI) computed using the Mantel-Haenszel method. Random effect model was used in the analysis of all variables as they were heterogeneous. Publication bias was tested by funnel plot and Egger's regression. RESULTS: Four RCT involving 3999 patients were included in the meta-analysis. Compared to usual-care group, patients who assigned to the EGDT group showed no significant difference in the rate of in-hospital mortality (OR 0.92; 95% CI, 0.72 - 1.19, P = 0.53, I2 = 59.11), 28 days mortality (OR 0.84; 95% CI, 0.62 - 1.15, P = 0.28, I2 = 62.07), 90 days mortality (OR 0.91; 95% CI, 0.76- 1.10, P = 0.34, I2 = 36.54), respiratory support (OR 1.05; 95% CI, 0.88-1.26, P = 0.59, I2 = 37.72), and the rate of renal support (OR 1.04; 95% CI, 0.84- 1.28, P = 0.7433, I2 = 0.00). However; there is significant difference in the rate of cardiovascular support as more support was needed in EGDT group (OR 1.41; 95% CI, 1.170-1.691, P = 0.00029, I2 = 43.57). CONCLUSIONS: In patients presented with early septic shock, the implementation of EGDT was not superior to usual care in improving in-hospital mortality, 28 days mortality, 90 days mortality, respiratory and renal support. Patients in the EGDT group required more cardiovascular support. CLINICAL IMPLICATIONS: This analysis demonstrated that EGDT has not reduced mortality as compared to usual care in patients with early septic shock. This raise the question on whether EGDT implementation will remain the base of treatment for severe sepsis. DISCLOSURE: The following authors have nothing to disclose: Mohsin Salih, Mohamed Ayan, Mlatoum Hamza, Moataz Gaddor, Mohamed Gashouta, Erika Leung, George Mansour, Haitham AlAshry, Mahmoud Traina No Product/Research Disclosure Information