title: The effects of moderate-dose steroid therapy in sepsis: A placebo-controlled, randomized study.
abstract: BACKGROUND
  Despite the new developments in sepsis treatment, mortality rate is still high. In this study, we aimed to investigate endocrinologic changes and the effects of moderate dosage steroid treatment in patients with sepsis.
  
  
  METHODS
  Fifty-five patients were included in the study. Basal hormonal evaluation and adrenocorticotropin hormone (ACTH) stimulation test were performed within 24 h in all patients. Both groups received standard treatment for sepsis. However, one group (steroid group) was also given intravenous prednisolone (20 mg/day). All-cause mortality was assessed during the first 28 days.
  
  
  RESULTS
  Analysis of the findings revealed a 59.3% mortality rate in steroid group compared with a 53.6% mortality rate in placebo group (p = 0.787). Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores, and peak cortisol and ACTH levels were significant factors related to mortality. The incidence of adrenal insufficiency (AI) was 10.9% and relative adrenal insufficiency (RAI) 36.4%. It was also found that steroid treatment did not have any effects on the mortality of patients with AI and RAI (p = 0.075 and p = 0.999, respectively).
  
  
  CONCLUSIONS
  Moderate-dose steroid therapy has no effect on mortality. Higher basal cortisol and peak cortisol levels were found more reliable mortality indicators compared to RAI. In addition, the study revealed that ACTH level was a significant indicator of mortality.
authors.affiliation: Associate Professor, Department of Infectious Diseases, School of Medicine, Erciyes University, Kayseri, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Yildiz
authors.forename: Fatih
authors.initials: F
authors.lastname: Tanriverdi
authors.forename: Serap
authors.initials: S
authors.lastname: Simsek
authors.forename: Bilgehan
authors.initials: B
authors.lastname: Aygen
authors.forename: Fahrettin
authors.initials: F
authors.lastname: Kelestimur