Table 1.
Comparison of selected randomized, controlled trials assessing the effects of therapeutic interventions on sepsis-related mortality between 2001 and 2013
| 1st author and year of publication | Therapeutic intervention assessed (inclusion time window) | Mortality rate in control arm (%) | Impact on mortality | Impact on adverse events | Effect of studied therapy* |
|---|---|---|---|---|---|
| Rivers 2001 [2] |
Early goal guided therapy (As soon as possible) |
49.2 |
Decreased mortality |
No difference |
Better |
| Bernard 2001 [3] |
Drotrecogin alfa (24 h) |
30.8 |
Decreased mortality |
Serious bleeding event |
|
| Annane 2002 [6] |
Hydrocortisone + fludrocortisone (3 h) |
63 |
Decreased mortality |
No difference |
|
| Cruz 2009 [7] |
Polymyxin B hemoperfusion (6 h) |
53 |
Decreased mortality |
Cartridge clotting Hypotension and tachycardia |
|
| Warren 2001 [8] |
Antithrombin III (6 h) |
38.7 |
No difference |
No difference |
No difference |
| Reinhart 2004 [9] |
Extracorporeal endotoxin adsorber (24 h) |
26 |
|
No difference |
|
| Heinrich 2006 [10] |
IG-MA enriched Ig** (not available) |
28.2 |
|
Not available |
|
| Annane 2007 [12] |
Norepinephrine plus dobutamine (24 h) |
34 |
|
No difference |
|
| Russel 2008 [14] |
Vasopressin (24 h) |
39 |
|
No difference |
|
| Ranieri 2012 [1] |
Drotrecogin alfa (24 h) |
24.2 |
|
No difference |
|
| Opal 2013 [15] |
Eritoran (12 h) |
26.9 |
|
No difference |
|
| Lopez 2004 [16] |
NO synthase inhibitor LNMA (72 h) |
49 |
Increased mortality |
Low cardiac output |
Worse |
| Abraham 2005 [11] |
Drotrecogin alfa (48 h) |
17 |
No difference |
Bleeding events |
|
| Brunkhorst 2008 [17] |
Insulin/pentastarch (12 h) |
26 |
No difference |
Hypoglycemia |
|
| Renal failure | |||||
| Coagulopathy | |||||
| Sprung 2008 [18] |
Hydrocortisone (72 h) |
31.5 |
No difference |
Increased infections events |
|
| Stephens 2008 [13] |
G-CSF*** (24 h) |
25 |
No difference |
Higher rate of new organ failure |
|
| Patel 2010 [19] |
Dopamine Early goal guided therapy |
43 |
No difference |
Arrhythmias |
|
| Annane 2010 [20] |
Corticosteroid/Insulin (not available) |
45.8 |
No difference |
Superinfection |
|
| Hypoglycemia | |||||
| Perner 2012 [21] | 6% HES 130/0.42 (24 h) | 43 | Increased mortality | Not available |
The selected trials were categorized in three groups depending on whether the effect of the studied intervention on mortality and/or serious adverse events was “better”: studied intervention leading to a significant reduction in mortality; “not different”: similar impact of the studied intervention on mortality and no severe adverse events; “worse”: studied intervention leading to a significant increase in mortality and/or to a significant increase in serious adverse events.
*Statistically significant difference vs. control arm: **neutropenic patients; ***granulocyte colony-stimulating factor.