Stress doses of hydrocortisone in septic shock: beneficial effects on opsonization-dependent neutrophil functions.
OBJECTIVE
To assess the effects of stress doses of hydrocortisone (HC) on clinical parameters and neutrophil functions in patients with septic shock.


METHODS
Prospective, double-blind, randomized, placebo-controlled study.


METHODS
Intensive care units of a university hospital.


METHODS
30 adult patients with septic shock.


METHODS
Patients were allocated to receive either HC (intravenous bolus of 100 mg preceding a continuous infusion 10 mg/h, n = 15) or placebo (n = 15), respectively. The effects of HC were assessed at baseline and after 24 h.


RESULTS
As compared with placebo-treated patients, administration of HC significantly decreased norepinephrine requirements (from 1.5 to 0.8 mg/h; p < 0.001), interleukin-6 serum concentrations (from 388.8 to 88.8 pg/ml; p < 0.02), and the spontaneous release of hydrogen peroxide (H2O2) by neutrophils (-33.0%; p < 0.05). Additionally, HC treatment preserved the autologous plasma-induced amplification of phagocytosis of zymosan particles [factor of opsonin-induced amplification of phagocytosis of unopsonized particles: 1.80 for placebo vs. 1.75 for HC at baseline (not significant between groups) and 0.50 for placebo vs. 1.75 for HC after 24 h of treatment (p < 0.05)]. These effects were paralleled by respective changes in the phagocytosis-associated H2O2 production.


CONCLUSIONS
In patients with septic shock stress doses of HC exert beneficial effects in terms of improvements in hemodynamics, decrease in pro-inflammatory mediators, and oxidative stress without the compromise of opsonization-dependent phagocytic neutrophil functions; thus, HC treatment does not aggravate non-specific immunosuppression but instead improves innate immunity in the early stage of septic shock.
Kaufmann
Ines
I
Ludwig Maximilians University, Klinikum Grosshadern, Clinic of Anesthesiology, 81377 Munich, Germany.
Briegel
Josef
J
Schliephake
Florian
F
Hoelzl
Alwin
A
Chouker
Alexander
A
Hummel
Theresia
T
Schelling
Gustav
G
Thiel
Manfred
M
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D006861:Hydrogen Peroxide / Q000378:metabolism; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000187:drug effects* / Q000378:metabolism; D009638:Norepinephrine / Q000008:administration & dosage; D010587:Phagocytosis; D011446:Prospective Studies; D012772:Shock, Septic / Q000188:drug therapy*; D018709:Statistics, Nonparametric
D000893:Anti-Inflammatory Agents; D015850:Interleukin-6; D006861:Hydrogen Peroxide; D006854:Hydrocortisone; D009638:Norepinephrine