Corticosteroids in cirrhotic shock show no mortality benefit but increase bleeding and organ failure risk

PURPOSE: To analyze whether the use of low-dose corticosteroids in cirrhotic patients with septic shock or other forms of vasopressor-dependent distributive shock translates into significant clinical benefits and reduced in-hospital mortality. METHODS: PubMed, Embase, and Cochrane CENTRAL were searched for randomized controlled trials (RCTs) and observational studies comparing the use of corticosteroids versus control in cirrhotic patients with septic shock or other distributive vasopressor-dependent shock. Outcomes were analyzed using risk ratios (RR) with 95 % confidence intervals (CIs) and mean differences (MD). Heterogeneity was assessed using the I statistic. RESULTS: Six studies (2 RCTs, 4 observational cohorts), totaling 514 patients, were included. Corticosteroids had no effect on in-hospital mortality (RR: 0.99; 95 % CI: 0.86-1.13; p = 0.832; I = 46.2 %), but reduced refractory shock related mortality (RR: 0.16; 95 % CI: 0.06-0.41; p < 0.001; I = 0 %) and increased shock resolution (RR: 1.42; 95 % CI: 1.13-1.78; p = 0.003; I = 52.3 %). No benefit was observed in vasopressor-free days (MD: 2.06; 95 % CI: -0.86 to 4.99; p = 0.166; I = 58.6 %). Adverse events were higher for gastrointestinal bleeding (RR: 2.73; 95 % CI: 1.15-6.52; p = 0.023; I = 0 %) and new organ failure (RR: 1.42; 95 % CI: 1.01-1.99; p = 0.045; I = 0 %). CONCLUSION: Low-dose corticosteroids in cirrhotic patients with septic or vasopressor-dependent distributive shock show limited benefit, as improved shock resolution and reduced shock-related mortality did not translate into in-hospital survival and may increase the risk of severe adverse events.