Abstract
Various trials and meta-analyses have reported conflicting results concerning the application of early goal-directed therapy (EGDT) for sepsis and septic shock. The aim of this study was to update the evidence by performing a systematic review and meta-analysis. Multiple databases were searched from initial through August, 2016 for randomized controlled trials (RCTs) which investigated the associations between the use of EGDT and mortality in patients with sepsis or septic shock. Meta-analysis was performed using random-effects model and heterogeneity was examined through subgroup analyses. The primary outcome of interest was patient all-cause mortality including hospital or ICU mortality. Seventeen RCTs including 6207 participants with 3234 in the EGDT group and 2973 in the control group were eligible for this study. Meta-analysis showed that EGDT did not significantly reduce hospital or intensive care unit (ICU) mortality (relative risk [RR] 0.89, 95% CI 0.78 to 1.02) compared with control group for patients with sepsis or septic shock. The findings of subgroup analyses stratified by study region, number of research center, year of enrollment, clinical setting, sample size, timing of EGDT almost remained constant with that of the primary analysis. Our findings provide evidence that EGDT offers neutral survival effects for patients with sepsis or septic shock. Further meta-analyses based on larger well-designed RCTs or individual patient data meta-analysis are required to explore the survival benefits of EDGT in patients with sepsis or septic shock.
Highlights
Severe sepsis and septic shock are one of the commonest life-threatening conditions in critically ill patients with a high mortality rate ranging from 15% to 50% [1, 2]
17 randomized controlled trials (RCTs) including 6207 participants with 3234 in the experimental group and 2973 in the control group were enrolled for analysis
This systematic review and meta-analysis involving the available RCTs on the impact of early-goal directed therapy (EGDT) on hospital or intensive care unit (ICU) mortality for patients with sepsis and septic shock did not show a significant reduced risk of hospital/ICU all-cause mortality associated with the use of EGDT
Summary
Severe sepsis and septic shock are one of the commonest life-threatening conditions in critically ill patients with a high mortality rate ranging from 15% to 50% [1, 2]. Some studies reported survival benefits [10,11,12,13, 17] while others, especially some recent RCTs and meta-analysis showed no survival benefits for patients receiving EGDT compared with those with usual care [7,8,9, 18,19,20]. We performed this www.impactjournals.com/oncotarget systematic review aimed at updating the current evidence from RCTs to determine the survival effect of EGDT compared with that of usual care in sepsis and septic shock patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
