Early, Goal-Directed Therapy No Benefit in Septic Shock

Patient-level meta-analysis shows similar mortality at 90 days for EGDT and usual care
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FRIDAY, March 24, 2017 (HealthDay News) -- Early, goal-directed therapy (EGDT) does not reduce mortality from septic shock at 90 days, according to a patient-level meta-analysis published online March 21 in the New England Journal of Medicine. The research was published to coincide with the annual International Symposium on Intensive Care and Emergency Medicine, held from March 21 to 24 in Brussels.

Kathryn M. Rowan, Ph.D., from the Intensive Care National Audit and Research Centre in London, and colleagues pooled data from three recent trials to improve statistical power and explore heterogeneity of treatment effect of EGDT. Data were included for 3,723 patients at 138 hospitals in seven countries.

The researchers found that 90-day mortality was similar for EGDT and usual care (24.9 versus 25.4 percent; adjusted odds ratio, 0.97; 95 percent confidence interval, 0.82 to 1.14; P = 0.68). Compared with usual care, EGDT was associated with greater mean use of intensive care (5.3 ± 7.1 versus 4.9 ± 7.0 days; P = 0.04) and cardiovascular support (1.9 ± 3.7 versus 1.6 ± 2.9 days; P = 0.01); there were no significant differences in other outcomes, although costs were higher with EGDT.

"In this meta-analysis of individual patient data, EGDT did not result in better outcomes than usual care and was associated with higher hospitalization costs across a broad range of patient and hospital characteristics," the authors write.

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