Riesgo de hemorragia gastrointestinal asociado al uso de corticoides en los pacientes críticos: revisión de revisiones sistemáticas y metaanálisis

Gastrointestinal bleeding (GIB) has been associated with corticosteroid use, leading to the routine implementation of gastric prophylaxis in critically ill patients. However, the evidence remains contradictory. This systematic review of systematic reviews (SR) and meta-analysis aimed to synthesize the available evidence regarding the risk of GIB in critically ill patients treated with corticosteroids.

Systematic reviews published between 2019 and 2024 were identified, including studies that evaluated patients over 16 years old in critical condition receiving corticosteroids. Out of 365 retrieved studies, 7 met the inclusion criteria. The quality of the evidence was assessed using AMSTAR II. Additionally, a de novo meta-analysis was conducted using RevMan 5.4 to integrate outcomes related to GIB risk, intensive care unit (ICU) mortality, and hospital length of stay.

Regarding GIB, the analysis included 53 randomized controlled trials (RCTs) with a total of 29,701 participants, showing a global relative risk (RR) of 1.13 (95% CI: 0.97-1.33). For mortality, the analysis of 23 RCTs with 4,596 participants indicated an RR of 0.85 (95% CI: 0.79-0.92), with high certainty of evidence. Concerning ICU length of stay, 22 RCTs with 4,635 participants reported a mean difference of −0.66 days (95% CI: −1.69 to 0.37).

This review indicates that corticosteroid use in critically ill patients is not associated with a significant increase in GIB risk. Furthermore, corticosteroids have been shown to reduce ICU mortality, reinforcing their role in the management of critically ill patients.