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Letters | October 21, 2009

Corticosteroid Therapy for Severe Sepsis and Septic Shock—Reply

Djillali Annane, MD, PhD

JAMA. 2009;302(15):1643-1645. doi:10.1001/jama.2009.1482.

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In Reply: Dr Minneci and colleagues suggest that potential publication bias may have influenced the results of our meta-analysis. Testing the asymmetry of the funnel plot (Figure) as proposed by Egger¹ suggests significant asymmetry (P = .01). However, because of mathematical links between the log odds ratio and its standard error, the Egger method may produce a false-positive result.²

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Scatterplot of the intervention effect estimates (log risk ratio [RR]) from the 12 individual studies on prolonged treatment with low-dose corticosteroids against each study precision (standard error of log RR). Lines define areas according to significance levels (1%, 5%, and 10%). Because the precision of the intervention effect estimate is proportional to the study's size, effect estimates from small studies scatter more widely at the bottom of the graph, with the spread narrowing among larger studies.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

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October 21, 2009

Corticosteroid Therapy for Severe Sepsis and Septic Shock

Peter C. Minneci, MD; Katherine J. Deans, MD; Charles Natanson, MD

JAMA. 2009;302(15):1643-1645. doi:10.1001/jama.2009.1480.

October 21, 2009

Corticosteroid Therapy for Severe Sepsis and Septic Shock

Rafael Barberena Moraes, MD; Mauro Antonio Czepielewski, MD, PhD

JAMA. 2009;302(15):1643-1645. doi:10.1001/jama.2009.1481.

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Annane D. Corticosteroid Therapy for Severe Sepsis and Septic Shock—Reply. JAMA. 2009;302(15):1643-1645. doi:10.1001/jama.2009.1482.

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