Gradual vs abrupt discontinuation of corticosteroids in septic shock: a systematic review and meta-analysis
M Machado, V A G Galeano, R P Silva, G C Moraes, G L Soares, B S F Jorge, S R Fatima, S M H Mehdi, L Gioli-PereiraAbstract
Background/Introduction
Corticosteroids are recommended as adjunctive therapy in patients with septic shock. However, evidence guiding the optimal strategy for corticosteroid discontinuation - gradual tapering versus abrupt cessation - remains limited and inconsistent.
Purpose
To evaluate clinical outcomes associated with gradual versus abrupt discontinuation of corticosteroids in patients with septic shock.
Methods
PubMed, Embase and Cochrane databases were searched to identify studies comparing gradual versus abrupt discontinuation of corticosteroids in septic shock. The reported outcomes were (1) vasopressor reinitiation, (2) intensive care unit (ICU) length of stay, (3) hospital mortality and (4) hyperglycemia. Odds ratios (ORs) and their 95% confidence intervals (CIs) were computed with the use of a random-effects model. Mean differences (MDs) were computed for continuous outcomes. Heterogeneity was examined with I2 statistics. Statistical analysis was performed using R (RStudio version 2026.01.0, Build 392).
Results
Four retrospective cohort studies comprising 925 patients (460 abrupt, 465 gradual) were included. Abrupt discontinuation was associated with lower odds of vasopressor reinitiation compared with gradual tapering (OR 0.41; 95% CI 0.28–0.59; p < 0.0001; I2 = 0%; 4 studies). ICU length of stay was shorter in the abrupt discontinuation group (MD −2.73 days; 95% CI −4.19 to −1.28; p < 0.01; I2 = 0%; 4 studies). Hospital mortality did not differ significantly between groups (OR 1.30; 95% CI 0.75–2.26; p = 0.35; I2 = 59.1%; 3 studies). The effect on hyperglycemia was inconclusive due to substantial heterogeneity (OR 0.65; 95% CI 0.20–2.10; p = 0.47; I2 = 87.9%; 3 studies).
Conclusions
Among patients with septic shock, abrupt corticosteroid discontinuation was associated with lower vasopressor reinitiation rates and shorter ICU length of stay compared with gradual tapering, without a significant difference in hospital mortality. Prospective randomized trials are warranted to define the optimal corticosteroid discontinuation strategy.