Corticosteroids reduced 28-day mortality (27 trials; n = 3176; risk ratio ( RR ) , 95% confidence interval ( CI ) to ; P value = , random-effects model). The quality of evidence for this outcome was downgraded from high to low for imprecision (upper limit of 95% CI = 1) and for inconsistency (significant heterogeneity across trial results). Heterogeneity was related in part to the dosing strategy. Treatment with a long course of low-dose corticosteroids significantly reduced 28-day mortality (22 trials; RR , 95% CI to ; P value = , fixed-effect model). The quality of evidence was downgraded from high to moderate for inconsistency (owing to non-significant effects shown by one large trial ). Corticosteroids also reduced mortality rate in the intensive care unit (13 trials; RR , 95% CI to ; P value = , random-effects model) and at the hospital (17 trials; RR , 95% CI to ; P value = , random-effects model). Quality of the evidence for in-hospital mortality was downgraded from high to moderate for inconsistency and imprecision (upper limit of 95% CI for RR approaching 1). Corticosteroids increased the proportion of shock reversal by day seven (12 trials; RR , 95% CI to ; P value = ) and by day 28 (seven trials; n = 1013; RR , 95% CI to ; P value = ) and reduced the SOFA score by day seven (eight trials; mean difference ( MD ) -, 95% CI - to -; P value < , random-effects model) and survivors' length of stay in the intensive care unit (10 trials; MD -, 95% CI - to -; P value = , fixed-effect model) without inducing gastroduodenal bleeding (19 trials; RR , 95% CI 0. 92 to ; P value = , fixed-effect model), superinfection (19 trials; RR , 95% CI to ; P value = , fixed-effect model) or neuromuscular weakness (three trials; RR , 95% CI to ; P value = , fixed-effect model). Corticosteroid increased the risk of hyperglycaemia (13 trials; RR , 95% CI to ; P value < , fixed-effect model) and hypernatraemia (three trials; RR , 95% CI to ; P value < , fixed-effect model).
This review explores the condition of muscle dysmorphia (MD) and its relationship with anabolic androgenic steroids (AAS). Particular emphasis is placed upon whether anabolic steroids are a predisposing, precipitating or perpetuating factor of MD. Furthermore, psychiatric complications of AAS abuse are examined. The current evidence from the literature suggests that AAS (ab)use is possibly a perpetuating factor in the evolution of MD. Psychiatric complications of AAS include mood and behavior changes, perceptual abnormalities, and withdrawal symptoms. In addition, there appears to be a credible dependence theory to AAS in fruition.
Anabolic processes tend toward "building up" organs and tissues . These processes produce growth and differentiation of cells and increase in body size, a process that involves synthesis of complex molecules . Examples of anabolic processes include the growth and mineralization of bone and increases in muscle mass. Endocrinologists have traditionally classified hormones as anabolic or catabolic, depending on which part of metabolism they stimulate. The classic anabolic hormones are the anabolic steroids , which stimulate protein synthesis, muscle growth, and insulin .  The balance between anabolism and catabolism is also regulated by circadian rhythms , with processes such as glucose metabolism fluctuating to match an animal's normal periods of activity throughout the day.