Description

Critical review of:Annane D, Sebille V, Charpentier C. Effect of treatment with low doses of Hydrocortisone and Fludrocortisone on mortality in patients with Septic Shock. JAMA 2002; 288: 862-871.

Septic shock is a common disease requiring admission to intensive care. The current incidence is about 3 cases per 1000 general population in the USA, with a mortality rate of around 30-50%.

Patients with septic shock may suffer from relative adrenocortical insufficiency. It seems rational to replace these deficiencies, and steroid supplementation in sepsis has been investigated several times over the years with varying results. Large doses given early in the disease process have an adverse effect on mortality, while the results from smaller doses given later in the illness have shown a trend towards improved survival, and steroid therapy for sepsis is currently undergoing a “second birth”.

Annane and colleagues conducted a multicentre randomised trial over four years comparing low dose steroid replacement with placebo. They found a reduction in mortality among patients with an inadequate cortisol response to a short corticotropin test.