Effect of corticosteroids on nuclear factor-kappaB activation and hemodynamics in late septic shock.
OBJECTIVE
To describe the underlying pathophysiologic mechanisms of the effect of corticosteroids in a patient with late septic shock.


METHODS
Case report.


METHODS
The medical intensive care unit at University Medical Center Utrecht.


METHODS
An 86-yr-old female patient with late septic shock requiring mechanical ventilation and vasopressive agents.


METHODS
Administration of hydrocortisone, 300 mg daily.


RESULTS
Within 3 days of corticosteroid treatment, the patient could be weaned of vasopressive agents and mechanical ventilation. Serum C-reactive protein levels normalized. Nuclear factor-kappaB activation in unstimulated and in vitro lipopolysaccharide-stimulated peripheral blood mononuclear cells decreased to background level within 5 days. Repeated functional tests of the hypothalamic-pituitary-adrenal axis were normal.


CONCLUSIONS
Our data suggest that the pathophysiologic mechanism behind the clinical effects of supraphysiologic doses of corticosteroids in late septic shock is directly related to the inhibition of nuclear factor-kappaB in peripheral blood mononuclear cells.
van Leeuwen
H J
HJ
Division of Internal Medicine and Dermatology, Department of Intensive Care and Clinical Toxicology, University Medical Center Utrecht, Utrecht, The Netherlands.
van der Bruggen
T
T
van Asbeck
B S
BS
Boereboom
F T
FT
D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D016328:NF-kappa B / Q000037:antagonists & inhibitors / Q000097:blood*; D012772:Shock, Septic / Q000188:drug therapy* / Q000503:physiopathology
D000893:Anti-Inflammatory Agents; D016328:NF-kappa B; D002097:C-Reactive Protein; D006854:Hydrocortisone