Is Early Goal-Directed Therapy or Standard Therapy More Effective in Decreasing Mortality Among Patients With Sepsis?

In the systematic review, 19,998 patients were included from 6 randomized trials (n=4,342) and 31 observational studies (n=15,656). The pooled analysis demonstrated a 23% reduction in the risk of mortality in patients treated with early goal-directed therapy (relative risk=0.77; 95% confidence interval 0.71 to 0.83; P<.001). This reduction was not observed in the randomized studies (relative risk=0.92; 95% confidence interval 0.78 to 1.07; P=.27). A meta-regression analysis of potential differences between the randomized and the observational studies revealed that the only factors associated with the mortality differences between early goal-directed therapy and control were the following: time to first antibiotic, and antibiotic administration within 6, 4, and 3 hours (Table 1).

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