Corticosteroid Therapy for Severe Sepsis and Septic Shock
- Rafael Barberena Moraes, MD tchemoraes@hotmail.com;
- Mauro Antonio Czepielewski, MD, PhDDivision of EndocrinologyUniversidade Federal do Rio Grande do Sul School of MedicinePorto Alegre, Brazil
Since this article does not have an abstract, we have provided the first 150 words of the full text.
- KEYWORDS:
- ADRENAL CORTEX HORMONES
- CLINICAL TRIALS AS TOPIC
- CRITICAL CARE
- DATA INTERPRETATION, STATISTICAL
- DRUG THERAPY
- KAPLAN-MEIERS ESTIMATE
- MORTALITY
- SEPSIS
- SHOCK, SEPTIC
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 …
