A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators

Derek C Angus, Amber Barnato, Derek Bell, Rinaldo Bellomo, Cherrin Chong, Timothy J Coats, Andrew Ross Davies, Anthony Delaney, David A Harrison, Anna Holdgate, Belinda Duval Howe, David T Huang, Theodore John Iwashyna, John A Kellum, Sandra Lois Peake, Francis Pike, Michael C Reade, Kathy Rowan, Mervyn Singer, Steven A R Webb & 3 others Lisa A Weissfeld, Donald M Yealy, John Duncan Young

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Abstract

Purpose: To determine whether early goal-directed therapy (EGDT) reduces mortality compared with other resuscitation strategies for patients presenting to the emergency department (ED) with septic shock. Methods: Using a search strategy of PubMed, EmBase and CENTRAL, we selected all relevant randomised clinical trials published from January 2000 to January 2015. We translated non-English papers and contacted authors as necessary. Our primary analysis generated a pooled odds ratio (OR) from a fixed-effect model. Sensitivity analyses explored the effect of including non-ED studies, adjusting for study quality, and conducting a random-effects model. Secondary outcomes included organ support and hospital and ICU length of stay. Results: From 2395 initially eligible abstracts, five randomised clinical trials (n = 4735 patients) met all criteria and generally scored high for quality except for lack of blinding. There was no effect on the primary mortality outcome (EGDT: 23.2 [495/2134] versus control: 22.4 [582/2601]; pooled OR 1.01 [95 CI 0.88?1.16], P = 0.9, with heterogeneity [I2 = 57 ; P = 0.055]). The pooled estimate of 90-day mortality from the three recent multicentre studies (n = 4063) also showed no difference [pooled OR 0.99 (95 CI 0.86?1.15), P = 0.93] with no heterogeneity (I2 = 0.0 ; P = 0.97). EGDT increased vasopressor use (OR 1.25 [95 CI 1.10?1.41]; P <0.001) and ICU admission [OR 2.19 (95 CI 1.82?2.65); P <0.001]. Including six non-ED randomised trials increased heterogeneity (I2 = 71 ; P <0.001) but did not change overall results [pooled OR 0.94 (95 CI 0.82 to 1.07); P = 0.33]. Conclusion: EGDT is not superior to usual care for ED patients with septic shock but is associated with increased utilisation of ICU resources.
Original languageEnglish
Pages (from-to)1549 - 1560
Number of pages12
JournalIntensive Care Medicine
Volume41
Issue number9
DOIs
Publication statusPublished - 2015

Cite this

Angus, Derek C ; Barnato, Amber ; Bell, Derek ; Bellomo, Rinaldo ; Chong, Cherrin ; Coats, Timothy J ; Davies, Andrew Ross ; Delaney, Anthony ; Harrison, David A ; Holdgate, Anna ; Howe, Belinda Duval ; Huang, David T ; Iwashyna, Theodore John ; Kellum, John A ; Peake, Sandra Lois ; Pike, Francis ; Reade, Michael C ; Rowan, Kathy ; Singer, Mervyn ; Webb, Steven A R ; Weissfeld, Lisa A ; Yealy, Donald M ; Young, John Duncan. / A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators. In: Intensive Care Medicine. 2015 ; Vol. 41, No. 9. pp. 1549 - 1560.
@article{84c5e9152da1427cbda6b55e001facbb,
title = "A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators",
abstract = "Purpose: To determine whether early goal-directed therapy (EGDT) reduces mortality compared with other resuscitation strategies for patients presenting to the emergency department (ED) with septic shock. Methods: Using a search strategy of PubMed, EmBase and CENTRAL, we selected all relevant randomised clinical trials published from January 2000 to January 2015. We translated non-English papers and contacted authors as necessary. Our primary analysis generated a pooled odds ratio (OR) from a fixed-effect model. Sensitivity analyses explored the effect of including non-ED studies, adjusting for study quality, and conducting a random-effects model. Secondary outcomes included organ support and hospital and ICU length of stay. Results: From 2395 initially eligible abstracts, five randomised clinical trials (n = 4735 patients) met all criteria and generally scored high for quality except for lack of blinding. There was no effect on the primary mortality outcome (EGDT: 23.2 [495/2134] versus control: 22.4 [582/2601]; pooled OR 1.01 [95 CI 0.88?1.16], P = 0.9, with heterogeneity [I2 = 57 ; P = 0.055]). The pooled estimate of 90-day mortality from the three recent multicentre studies (n = 4063) also showed no difference [pooled OR 0.99 (95 CI 0.86?1.15), P = 0.93] with no heterogeneity (I2 = 0.0 ; P = 0.97). EGDT increased vasopressor use (OR 1.25 [95 CI 1.10?1.41]; P <0.001) and ICU admission [OR 2.19 (95 CI 1.82?2.65); P <0.001]. Including six non-ED randomised trials increased heterogeneity (I2 = 71 ; P <0.001) but did not change overall results [pooled OR 0.94 (95 CI 0.82 to 1.07); P = 0.33]. Conclusion: EGDT is not superior to usual care for ED patients with septic shock but is associated with increased utilisation of ICU resources.",
author = "Angus, {Derek C} and Amber Barnato and Derek Bell and Rinaldo Bellomo and Cherrin Chong and Coats, {Timothy J} and Davies, {Andrew Ross} and Anthony Delaney and Harrison, {David A} and Anna Holdgate and Howe, {Belinda Duval} and Huang, {David T} and Iwashyna, {Theodore John} and Kellum, {John A} and Peake, {Sandra Lois} and Francis Pike and Reade, {Michael C} and Kathy Rowan and Mervyn Singer and Webb, {Steven A R} and Weissfeld, {Lisa A} and Yealy, {Donald M} and Young, {John Duncan}",
year = "2015",
doi = "10.1007/s00134-015-3822-1",
language = "English",
volume = "41",
pages = "1549 -- 1560",
journal = "Intensive Care Medicine",
issn = "0342-4642",
publisher = "Springer-Verlag London Ltd.",
number = "9",

}

Angus, DC, Barnato, A, Bell, D, Bellomo, R, Chong, C, Coats, TJ, Davies, AR, Delaney, A, Harrison, DA, Holdgate, A, Howe, BD, Huang, DT, Iwashyna, TJ, Kellum, JA, Peake, SL, Pike, F, Reade, MC, Rowan, K, Singer, M, Webb, SAR, Weissfeld, LA, Yealy, DM & Young, JD 2015, 'A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators', Intensive Care Medicine, vol. 41, no. 9, pp. 1549 - 1560. https://doi.org/10.1007/s00134-015-3822-1

A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators. / Angus, Derek C; Barnato, Amber; Bell, Derek; Bellomo, Rinaldo; Chong, Cherrin; Coats, Timothy J; Davies, Andrew Ross; Delaney, Anthony; Harrison, David A; Holdgate, Anna; Howe, Belinda Duval; Huang, David T; Iwashyna, Theodore John; Kellum, John A; Peake, Sandra Lois; Pike, Francis; Reade, Michael C; Rowan, Kathy; Singer, Mervyn; Webb, Steven A R; Weissfeld, Lisa A; Yealy, Donald M; Young, John Duncan.

In: Intensive Care Medicine, Vol. 41, No. 9, 2015, p. 1549 - 1560.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators

AU - Angus, Derek C

AU - Barnato, Amber

AU - Bell, Derek

AU - Bellomo, Rinaldo

AU - Chong, Cherrin

AU - Coats, Timothy J

AU - Davies, Andrew Ross

AU - Delaney, Anthony

AU - Harrison, David A

AU - Holdgate, Anna

AU - Howe, Belinda Duval

AU - Huang, David T

AU - Iwashyna, Theodore John

AU - Kellum, John A

AU - Peake, Sandra Lois

AU - Pike, Francis

AU - Reade, Michael C

AU - Rowan, Kathy

AU - Singer, Mervyn

AU - Webb, Steven A R

AU - Weissfeld, Lisa A

AU - Yealy, Donald M

AU - Young, John Duncan

PY - 2015

Y1 - 2015

N2 - Purpose: To determine whether early goal-directed therapy (EGDT) reduces mortality compared with other resuscitation strategies for patients presenting to the emergency department (ED) with septic shock. Methods: Using a search strategy of PubMed, EmBase and CENTRAL, we selected all relevant randomised clinical trials published from January 2000 to January 2015. We translated non-English papers and contacted authors as necessary. Our primary analysis generated a pooled odds ratio (OR) from a fixed-effect model. Sensitivity analyses explored the effect of including non-ED studies, adjusting for study quality, and conducting a random-effects model. Secondary outcomes included organ support and hospital and ICU length of stay. Results: From 2395 initially eligible abstracts, five randomised clinical trials (n = 4735 patients) met all criteria and generally scored high for quality except for lack of blinding. There was no effect on the primary mortality outcome (EGDT: 23.2 [495/2134] versus control: 22.4 [582/2601]; pooled OR 1.01 [95 CI 0.88?1.16], P = 0.9, with heterogeneity [I2 = 57 ; P = 0.055]). The pooled estimate of 90-day mortality from the three recent multicentre studies (n = 4063) also showed no difference [pooled OR 0.99 (95 CI 0.86?1.15), P = 0.93] with no heterogeneity (I2 = 0.0 ; P = 0.97). EGDT increased vasopressor use (OR 1.25 [95 CI 1.10?1.41]; P <0.001) and ICU admission [OR 2.19 (95 CI 1.82?2.65); P <0.001]. Including six non-ED randomised trials increased heterogeneity (I2 = 71 ; P <0.001) but did not change overall results [pooled OR 0.94 (95 CI 0.82 to 1.07); P = 0.33]. Conclusion: EGDT is not superior to usual care for ED patients with septic shock but is associated with increased utilisation of ICU resources.

AB - Purpose: To determine whether early goal-directed therapy (EGDT) reduces mortality compared with other resuscitation strategies for patients presenting to the emergency department (ED) with septic shock. Methods: Using a search strategy of PubMed, EmBase and CENTRAL, we selected all relevant randomised clinical trials published from January 2000 to January 2015. We translated non-English papers and contacted authors as necessary. Our primary analysis generated a pooled odds ratio (OR) from a fixed-effect model. Sensitivity analyses explored the effect of including non-ED studies, adjusting for study quality, and conducting a random-effects model. Secondary outcomes included organ support and hospital and ICU length of stay. Results: From 2395 initially eligible abstracts, five randomised clinical trials (n = 4735 patients) met all criteria and generally scored high for quality except for lack of blinding. There was no effect on the primary mortality outcome (EGDT: 23.2 [495/2134] versus control: 22.4 [582/2601]; pooled OR 1.01 [95 CI 0.88?1.16], P = 0.9, with heterogeneity [I2 = 57 ; P = 0.055]). The pooled estimate of 90-day mortality from the three recent multicentre studies (n = 4063) also showed no difference [pooled OR 0.99 (95 CI 0.86?1.15), P = 0.93] with no heterogeneity (I2 = 0.0 ; P = 0.97). EGDT increased vasopressor use (OR 1.25 [95 CI 1.10?1.41]; P <0.001) and ICU admission [OR 2.19 (95 CI 1.82?2.65); P <0.001]. Including six non-ED randomised trials increased heterogeneity (I2 = 71 ; P <0.001) but did not change overall results [pooled OR 0.94 (95 CI 0.82 to 1.07); P = 0.33]. Conclusion: EGDT is not superior to usual care for ED patients with septic shock but is associated with increased utilisation of ICU resources.

UR - http://goo.gl/7MqEDu

U2 - 10.1007/s00134-015-3822-1

DO - 10.1007/s00134-015-3822-1

M3 - Article

VL - 41

SP - 1549

EP - 1560

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

IS - 9

ER -