Low-dose hydrocortisone during severe sepsis: effects on microalbuminuria.
OBJECTIVE
The aim of this study was to investigate the effect of low-dose hydrocortisone on glomerular permeability measured by the microalbuminuria to creatinine ratio (MACR) and on other markers of sepsis in severe septic patients.


METHODS
Randomized prospective study.


METHODS
University intensive care unit.


METHODS
The study involved 40 patients with severe sepsis randomized into the hydrocortisone group (n = 20) and the standard therapy group (n = 20).


METHODS
The hydrocortisone group received standard therapy plus a continuous infusion of hydrocortisone for 6 days, whereas the standard therapy group received only standard therapy.


RESULTS
MACR, serum C-reactive protein, and procalcitonin concentrations were recorded every day from the day before the steroid therapy (T(0)) until the 6 days after (T(1), T(2), T(3), T(4), T(5), and T(6)). Concentrations in the hydrocortisone group and the standard therapy group were compared using Mann-Whitney test at each time. We also compared with Wilcoxon signed rank test the values determined in each group at T(0) with those at each subsequent time. Median MACR decreased from T(0) to T(6) in both patient groups; however, values were significantly lower in the hydrocortisone group from T(3) through to T(6). Median serum C-reactive protein also decreased from T(0) in both patient groups, with significantly lower values in the hydrocortisone group from T(3) through to T(6). There were no significant differences in procalcitonin between groups compared with baseline values or at any individual time point.


CONCLUSIONS
Low-dose hydrocortisone seems to reduce MACR and serum C-reactive protein but not procalcitonin in patients with severe sepsis. Further studies are needed to confirm these results and to understand the underlying molecular mechanisms.
Rinaldi
Simone
S
University of Florence, Department of Critical Care, Section of Anesthesiology and Intensive Care, Italy.
Adembri
Chiara
C
Grechi
Serenèlla
S
De Gaudio
A Raffaele
AR
D000368:Aged; D000419:Albuminuria / Q000188:drug therapy*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D003404:Creatinine / Q000652:urine; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D007362:Intensive Care Units; D008875:Middle Aged; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D018805:Sepsis / Q000097:blood / Q000188:drug therapy* / Q000652:urine
D000893:Anti-Inflammatory Agents; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D003404:Creatinine; D015740:Calcitonin Gene-Related Peptide; D006854:Hydrocortisone