Anabolic androgen therapy in critically ill adults: a systematic review and meta-analysis

Testosterone deficiency is common in critical illness; however, evidence that replacement improves clinically important outcomes remains equivocal. Critical illness causes a proinflammatory and catabolic state which contributes to muscle wasting, impaired recovery, and decreased immune function and wound healing. Accordingly, anabolic pathways have been proposed as therapeutic targets to mitigate these downstream complications. We conducted a systematic review and meta-analysis of randomized trials evaluating testosterone or anabolic-androgen steroid therapy initiated during ICU hospitalization in adults. Our objectives were to (1) estimate effects on clinically important outcomes (mortality, duration of mechanical ventilation, ICU and hospital length of stay, and adverse events) and (2) identify design and reporting limitations that should inform future studies.