Corticosteroid therapy in cardiogenic shock: A systematic review and meta-analysis

Introduction: Relative adrenal insufficiency and inflammation are associated with increased mortality in cardiogenic shock. In other shock states such as sepsis, guidelines recommend the administration of corticosteroids. Methods: We conducted a pre-registered (CRD420251042819) systematic review and meta-analysis, searching MEDLINE, Embase and Cochrane Central on 21 June 2025. We included randomised controlled trials and observational studies of adult patients with cardiogenic shock which compared corticosteroids to placebo or usual care. The primary outcome was acute mortality. Results: Of 3242 studies screened, eight studies (four randomised controlled trials and four observational cohort studies) were included with three observational studies of clearly-defined cardiogenic shock included in the primary analysis. There was substantial clinical heterogeneity across included studies of populations, interventions and observed mortality. Observational studies suggested between 7% and 29% of patients with cardiogenic shock received systemic corticosteroids. There was no evidence of an effect on acute mortality in unadjusted analysis (Risk Ratio = 1.05, 95% CI 0.98–1.13, p = 0.17), but there was high risk of residual confounding and a very low certainty of evidence. There was weak evidence of increased rates of hyperglycaemia and hospital-acquired infection, but this was defined heterogeneously and the certainty of evidence was very low. Conclusion: Our conclusions are limited by low study numbers, heterogeneity and uncertainty. There is insufficient evidence to determine the effect of corticosteroid use on acute mortality in cardiogenic shock. Further high-quality research is needed to assess the effect of corticosteroids on mortality in patients with cardiogenic shock.