title: CAGS and ACS evidence based reviews in surgery. 35: Efficacy and safety of low-dose hydrocortisone therapy in the treatment of septic shock.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of low-dose hydrocortisone therapy in patients with septic shock.
  
  
  METHODS
  Multicentre, randomized, double-blind, placebo-controlled trial.
  
  
  METHODS
  Nine centres (including 52 intensive care units) in Europe and the Middle East.
  
  
  METHODS
  Patients with clinical evidence of infection, evidence of systemic response to infection and onset of shock within the previous 72 hours (defined by systolic blood pressure < 90 mm Hg despite adequate fluid replacement or a need for vasopressors for at least 1 hour) and hypoperfusion or organ dysfunction attributable to sepsis.
  
  
  METHODS
  INTERVENTION group (n = 251) was randomly assigned to receive 50 mg of hydrocortisone intravenously, and the control group (n = 248) was randomly assigned to receive placebo every 6 hours for 5 days; the dose was tapered during a 6-day period.
  
  
  METHODS
  Death at 28 days in patients who did not have a response to corticotrophin.
  
  
  RESULTS
  In all, 233 (46.7%) patients did not have a response to corticotrophin (125 in the treatment group and 108 in the placebo group). At 28 days, there was no significant difference in mortality between patients in the 2 groups who did not have a response to corticotropin (39.2% in the treatment group and 36.1% in the placebo group, p = 0.69) or between those who had a response to corticotropin (28.8% in the treatment group and 28.7% in the placebo group, p = 1.00). At 28 days, 86 of 251 (34.3%) patients in the treatment group and 78 of 248 (31.5%) in the placebo group had died (p = 0.51). In the treatment group, shock was reversed more quickly than in the placebo group. However, there were more episodes of superinfection, including new sepsis and septic shock.
  
  
  CONCLUSIONS
  Hydrocortisone cannot be recommended as general adjuvant therapy for septic shock (vasopressor responsive), nor can corticotrophin testing be recommended to determine which patients should receive hydrocortisone therapy.
authors.affiliation: Mount Sinai Hospital, 60 Murray St., Toronto, Ontario.
authors.forename: Prosanto
authors.initials: P
authors.lastname: Chaudhury
authors.forename: John C
authors.initials: JC
authors.lastname: Marshall
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Solomkin