Effectiveness of Xuebijing injection for sepsis: an overview of systematic reviews and meta-analyses

Background: The effectiveness of Xuebijing injection (XBJ) on sepsis outcomes remain unclear, although a number of systematic reviews (SRs) and meta-analyses (MAs) on XBJ treatment for sepsis have been published. The aim of this overview is to evaluate the methodological quality and evidence quality of extant SRs/MAs and to provide comprehensive evidence of XBJ for sepsis. Methods: Eight databases were comprehensively searched to collect MAs and SRs of XBJ for sepsis from their inception to September 30, 2020. The Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system were used to evaluate the methodological quality of SRs/MAs and the evidence quality of outcomes extracted from the included reviews. Results: Twelve SRs/MAs were included for the overview, with number of randomized controlled trials (RCTs) from 8 to 49 and of participants from 399 to 3,884. According to the AMSTAR 2 results, all included SRs/MAs were rated as critically low-quality studies. According to the evaluation results of the GRADE system, out of 45 outcomes, only 1 (2.2%) was of high quality, only 10 (22.2%) were of moderate quality, 28 (62.2%) were of low quality, and 6 (13.3%) were of very low quality. Discussion: XBJ is promising in the treatment of sepsis, but high-quality evidence is still lacking. In the future, rigorous MAs are needed following methodological requirements to provide robust evidence for definitive conclusions.