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To the Editor: Dr Annane and colleagues¹ conducted a systematic review and meta-analysis of the use of corticosteroids in the treatment of sepsis and septic shock. In thinking about future research, we would like to raise a question about the statistical methods that have been used to evaluate shock reversal after steroid use. This is a situation of competing risks because another end point (death) may occur before shock reversal.

The trials that studied shock reversal (Figure 5 in the study by Annane et al) used the Kaplan-Meier method to identify time to shock reversal. As a tool of time-to-event analysis, this method is ideal for working with time to a single type of event. Kaplan-Meier analysis assumes independence between event and censoring, an assumption not met when analyzing shock reversal and death.^2-3 When there are competing events, such as death and shock reversal, Kaplan-Meier analysis gives a false picture . . . [Full Text of this Article]

Rafael Barberena Moraes, MD
tchemoraes@hotmail.com

Mauro Antonio Czepielewski, MD, PhD
Division of Endocrinology
Universidade Federal do Rio Grande do Sul School of Medicine
Porto Alegre, Brazil

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