title: Time course of organ failure in patients with septic shock treated with hydrocortisone: results of the Corticus study.
abstract: BACKGROUND
  Corticosteroids have been proposed to decrease morbidity and mortality in patients with septic shock. An impact on morbidity should be anticipated to be earlier and more easily detected than the impact on mortality.
  
  
  METHODS
  Prospective, randomized, double-blind, placebo-controlled study of 28-day mortality in patients with septic shock for <72 h who underwent a short high-dose ACTH test in 52 centers in 9 European countries. Patients received 11-day treatment with hydrocortisone or placebo. Organ dysfunction/failure was quantified by the use of the sequential organ failure assessment (SOFA) score.
  
  
  RESULTS
  From March 2002 to November 2005, 499 patients were enrolled (hydrocortisone 251, placebo 248). Both groups presented a similar SOFA score at baseline (hydrocortisone 10.8 ± 3.2 vs. placebo 10.7 ± 3.1 points). There was no difference in 28-day mortality between the two treatment groups (hydrocortisone 34.3% vs. placebo 31.5%). There was a decrease in the SOFA score of hydrocortisone-treated patients from day 0 to day 7 compared to the placebo-treated patients (p = 0.0027), driven by an improvement in cardiovascular organ dysfunction/failure (p = 0.0005) and in liver failure (p < 0.0001) in the hydrocortisone-treated patients.
  
  
  CONCLUSIONS
  Patients randomized to treatment with hydrocortisone demonstrated a faster decrease in total organ dysfunction/failure determined by the SOFA score, primarily driven by a faster improvement in cardiovascular organ dysfunction/failure. This organ dysfunction/failure improvement was not accompanied by a decreased mortality.
authors.affiliation: Unidade de Cuidados Intensivos Polivalente, Hospital de Santo António dos Capuchos, E.P.E, 1150-069, Lisbon, Portugal. r.moreno@mail.telepac.pt
authors.forename: R
authors.initials: R
authors.lastname: Moreno
authors.forename: C L
authors.initials: CL
authors.lastname: Sprung
authors.forename: D
authors.initials: D
authors.lastname: Annane
authors.forename: S
authors.initials: S
authors.lastname: Chevret
authors.forename: J
authors.initials: J
authors.lastname: Briegel
authors.forename: D
authors.initials: D
authors.lastname: Keh
authors.forename: M
authors.initials: M
authors.lastname: Singer
authors.forename: Y G
authors.initials: YG
authors.lastname: Weiss
authors.forename: D
authors.initials: D
authors.lastname: Payen
authors.forename: B H
authors.initials: BH
authors.lastname: Cuthbertson
authors.forename: J-L
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005060:Europe / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000627:therapeutic use*; D007362:Intensive Care Units; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012772:Shock, Septic / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D013997:Time Factors; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone