Investigators from France assessed whether low doses of corticosteroids improve survival in patients with septic shock.
Septic shock may be associated with relative adrenal insufficiency. Thus, a replacement therapy of low doses of corticosteroids has been proposed to treat septic shock.
A total of 300 adult patients in 19 intensive care units in France were studied between 1995 and 1999.
The patients fulfilled usual criteria for septic shock and were enrolled after undergoing a short corticotropin test.
They were then randomly assigned to receive either hydrocortisone (50 mg intravenous bolus every 6 hours) and fludrocortisone (50 µg tablet once daily) (n = 151) or matching placebos (n = 149) for 7 days.
The researchers measured the 28-day survival distribution in patients with relative adrenal insufficiency (nonresponders to the corticotropin test).
|Deaths among patients with relative renal insufficiency:|
| Journal of the American Medical Association |
One patient from the corticosteroid group was excluded from analyses because of consent withdrawal.
There were 229 nonresponders to the corticotropin test (placebo, 115; corticosteroids, 114) and 70 responders to the corticotropin test (placebo, 34; corticosteroids, 36).
In nonresponders, there were found to be 73 deaths (63%) in the placebo group and 60 deaths (53%) in the corticosteroid group (hazard ratio, 0.67).
Vasopressor therapy was withdrawn within 28 days in 46 patients (40%) in the placebo group and in 65 patients (57%) in the corticosteroid group (hazard ratio, 1.91).
There was no significant difference between groups in responders.
In addition, adverse event rates were similar in the 2 groups.
Dr Djillali Annane, of the Raymond Poincaré Hospital, Garches, concluded on behalf of fellow authors, "In our trial, a 7-day treatment with low doses of hydrocortisone and fludrocortisone significantly reduced the risk of death in patients with septic shock and relative adrenal insufficiency, without increasing adverse events."