Hydrocortisone Therapy for Patients with Septic Shock

• Published in: The New England journal of medicine Vol. 358; no. 2; pp. 111 - 124
• Main Authors: Sprung, Charles L, Annane, Djillali, Keh, Didier, Moreno, Rui, Singer, Mervyn, Freivogel, Klaus, Weiss, Yoram G, Benbenishty, Julie, Kalenka, Armin, Forst, Helmuth, Laterre, Pierre-Francois, Reinhart, Konrad, Cuthbertson, Brian H, Payen, Didier, Briegel, Josef
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 10-01-2008
• Subjects: Adrenal Glands - drug effects; Adrenal Glands - metabolism; Adrenocorticotropic Hormone - pharmacology; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Intravenous - pharmacology; Anti-Inflammatory Agents - adverse effects; Anti-Inflammatory Agents - metabolism; Anti-Inflammatory Agents - therapeutic use; Biological and medical sciences; Clinical trials; Consent; Double-Blind Method; Drug dosages; Drug therapy; Drug Therapy, Combination; Emergency and intensive care: infection, septic shock; Etomidate - pharmacology; Female; General aspects; Hormones - pharmacology; Humans; Hydrocortisone - adverse effects; Hydrocortisone - metabolism; Hydrocortisone - therapeutic use; Injections, Intravenous; Intensive care medicine; Kaplan-Meier Estimate; Male; Medical sciences; Mental competency; Middle Aged; Shock, Septic - drug therapy; Shock, Septic - microbiology; Shock, Septic - mortality; Studies; Treatment Failure; Human; Infection; Medicine; Sepsis syndrome; Corticosteroid; Treatment; Steroid hormone; Adrenal hormone; Antiinflammatory agent; Patient; Septic shock; Hydrocortisone
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa071366

The benefit of adjuvant use of corticosteroids in patients with septic shock remains controversial. In this international, multicenter, double-blind, placebo-controlled trial, adjunctive therapy with hydrocortisone in nearly 500 patients with septic shock was not found to be clinically helpful. This lack of benefit was also found in a subgroup of patients who did not have a response to a corticotropin test.
Adjunctive therapy with hydrocortisone in nearly 500 patients with septic shock was not found to be clinically helpful. This lack of benefit was also found in a subgroup of patients who did not have a response to a corticotropin test.
Severe sepsis is a major cause of mortality and morbidity worldwide.
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,
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Septic shock, the most severe manifestation, occurs in 2 to 20% of inpatients.
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The incidence of the condition has been rising,
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and a death rate of 33 to 61% has been reported in the placebo groups of multicenter trials.
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–
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The use of corticosteroids as an adjunctive therapy has been controversial for decades.
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After the study by Schumer,
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a short course of high-dose corticosteroids became accepted therapy. Subsequent studies, however, did not confirm a survival benefit with this regimen and suggested an increase in superinfection-related mortality.
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–
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Studies . . .