title: Low-dose hydrocortisone treatment for patients with septic shock: a pilot study comparing 3days with 7days.
abstract: OBJECTIVE
  Although there is controversy regarding the benefit of low-dose corticosteroid therapy in patients with septic shock, the Surviving Sepsis Campaign has advocated that low-dose intravenous hydrocortisone be used to treat adult septic shock patients. This study investigated the effect of the duration of a stress dose of hydrocortisone on survival of septic shock patients with relative adrenal insufficiency.
  
  
  METHODS
  One hundred and thirty consecutive patients who met the American College of Chest Physicians/Society of Critical Care Medicine criteria for septic shock were included in the study. An additional inclusion criterion was vasopressor support after fluid resuscitation. The primary end-point was 28-day mortality, and the secondary end-points were shock reversal and mortality in the intensive care unit and hospital. All eligible patients were prospectively randomized to receive hydrocortisone treatment for 3 or 7days. Hydrocortisone treatment was started at a dose of 50mg every 6h.
  
  
  RESULTS
  Baseline data at recruitment did not differ between the two groups. After 28days, mortality did not differ between the 3- and 7-day treatment groups (33.8% vs 36.9%, P=0.629). Mortality rates in the intensive care unit and hospital did not differ significantly between the two groups. The median time to withdrawal of vasopressor therapy was 5.0days in the 3-day treatment group and 6.4days in the 7-day treatment group (P=0.102).
  
  
  CONCLUSIONS
  This pilot study showed that in patients with septic shock and relative adrenal insufficiency, 28-day mortality did not differ between those treated with low-dose hydrocortisone for 3 or 7days.
authors: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
authors: Jin Won
authors: JW
authors: Huh
authors: Hye-Sook
authors: HS
authors: Choi
authors: Chae-Man
authors: CM
authors: Lim
authors: Younsuck
authors: Y
authors: Koh
authors: Yeon Mok
authors: YM
authors: Oh
authors: Tae Sun
authors: TS
authors: Shim
authors: Sang D O
authors: SD
authors: Lee
authors: Woo Sung
authors: WS
authors: Kim
authors: Dong Soon
authors: DS
authors: Kim
authors: Sang-Bum
authors: SB
authors: Hong
mesh_terms: D000309:Adrenal Insufficiency / Q000150:complications*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003422:Critical Care; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D018805:Sepsis / Q000188:drug therapy; D012772:Shock, Septic / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone