Physiological-dose steroid therapy in sepsis [ISRCTN36253388].
BACKGROUND
The aim of the study was to assess the prognostic importance of basal cortisol concentrations and cortisol response to corticotropin, and to determine the effects of physiological dose steroid therapy on mortality in patients with sepsis.


METHODS
Basal cortisol level and corticotropin stimulation test were performed within 24 hours in all patients. One group (20 patients) received standard therapy for sepsis and physiological-dose steroid therapy for 10 days; the other group (20 patients) received only standard therapy for sepsis. Basal cortisol level was measured on the 14th day in patients who recovered. The outcome of sepsis was compared.


RESULTS
Only Sequential Organ Failure Assessment (SOFA) score was found related to mortality, independent from other factors in multivariate analysis. No significant difference was found between the changes in the percentage of SOFA scores of the steroid therapy group and the standard therapy group in survivors, nor between the groups in basal and peak cortisol levels, cortisol response to corticotropin test and mortality. The mortality rates among patients with occult adrenal insufficiencies were 40% in the steroid therapy group and 55.6% in the standard therapy group.


CONCLUSIONS
There was a trend towards a decrease in the mortality rates of the patients with sepsis who received physiological-dose steroid therapy. In the advancing process from sepsis to septic shock, adrenal insufficiency was not frequent as supposed. There was a trend (that did not reach significance) towards a decrease in the mortality rates of the patients with sepsis who received physiological-dose steroid therapy.
Department of Infectious Diseases, School of Medicine, Erciyes University, Kayseri, Turkey. yildizorhan@hotmail.com
Orhan
O
Yildiz
Mehmet
M
Doganay
Bilgehan
B
Aygen
Muhammet
M
Güven
Fahrettin
F
Keleştimur
Ahmet
A
Tutuû
D000309:Adrenal Insufficiency / Q000209:etiology; D000324:Adrenocorticotropic Hormone; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000627:therapeutic use*; D008875:Middle Aged; D015999:Multivariate Analysis; D018805:Sepsis / Q000150:complications / Q000188:drug therapy*; D012772:Shock, Septic / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014666:Vasomotor System / Q000187:drug effects
D000893:Anti-Inflammatory Agents; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone