title: Early administration of hydrocortisone replacement after the advent of septic shock: impact on survival and immune response*.
abstract: OBJECTIVE
  To investigate the impact of early initiation of hydrocortisone therapy on the clinical course of septic shock and on cytokine release.
  
  
  METHODS
  Prospective study in patients with septic shock treated with low doses of hydrocortisone.
  
  
  METHODS
  ICUs and general wards.
  
  
  METHODS
  Over a 2-year period, 170 patients with septic shock treated with low doses of hydrocortisone were enrolled. Blood was sampled from 34 patients for isolation of peripheral blood mononuclear cells and cytokine stimulation before and 24 hours after the start of hydrocortisone.
  
  
  METHODS
  None.
  
  
  RESULTS
  After quartile analysis, patients were divided into those with early initiation of hydrocortisone (< 9 hr after vasopressors, n = 46) and those with late initiation of hydrocortisone (> 9 hr after vasopressors, n = 124). After adjusting for disease severity and type of infection, a protective effect of early hydrocortisone administration against unfavorable outcome was found (hazard ratio, 0.20; p = 0.012). Time of discontinuation of vasopressors was earlier among patients with initiation of hydrocortisone within 9 hours. Production of tumor necrosis factor-α was lower among patients who had had hydrocortisone early.
  
  
  CONCLUSIONS
  In patients receiving hydrocortisone for septic shock, early initiation of treatment was associated with improved survival. This treatment was also associated with attenuated stimulation of tumor necrosis factor-α.
authors.affiliation: 1Intensive Care Unit, Korgialeneion-Benakeion Hospital, Athens, Greece. 22nd Department of Critical Care Medicine, University of Athens, Medical School, Athens, Greece. 3Intensive Care Unit, Ptolemaida General Hospital, Ptolemaida, Greece. 4Intensive Care Unit, Korinthos General Hospital, Korinthos, Greece. 5Department of Internal Medicine, Zakynthos General Hospital, Zakynthos, Greece. 6Intensive Care Unit, Ippokrateion Athens General Hospital, Athens, Greece. 74th Department of Internal Medicine, University of Athens, Medical School, Athens, Greece. 81st Department of Critical Care Medicine, University of Athens, Medical School, Athens, Greece. 9Department of Therapeutics, University of Athens, Medical School, Athens, Greece. 10Intensive Care Unit, "G.Gennimatas" Hospital, Thessaloniki, Greece. 11Department of Infectious Diseases, Patras University Hospital, Rion, Greece.
authors.forename: Chrysostomos S
authors.initials: CS
authors.lastname: Katsenos
authors.forename: Anastasia N
authors.initials: AN
authors.lastname: Antonopoulou
authors.forename: Efterpi N
authors.initials: EN
authors.lastname: Apostolidou
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Ioakeimidou
authors.forename: Georgia Th
authors.initials: GT
authors.lastname: Kalpakou
authors.forename: Metaxia N
authors.initials: MN
authors.lastname: Papanikolaou
authors.forename: Aikaterini C
authors.initials: AC
authors.lastname: Pistiki
authors.forename: Margarita C
authors.initials: MC
authors.lastname: Mpalla
authors.forename: Michael D
authors.initials: MD
authors.lastname: Paraschos
authors.forename: Maria A
authors.initials: MA
authors.lastname: Patrani
authors.forename: Maria E
authors.initials: ME
authors.lastname: Pratikaki
authors.forename: Theodoros A
authors.initials: TA
authors.lastname: Retsas
authors.forename: Athina A
authors.initials: AA
authors.lastname: Savva
authors.forename: Spyridoula D
authors.initials: SD
authors.lastname: Vassiliagkou
authors.forename: Alexandra A
authors.initials: AA
authors.lastname: Lekkou
authors.forename: Ioanna
authors.initials: I
authors.lastname: Dimopoulou
authors.forename: Christina
authors.initials: C
authors.lastname: Routsi
authors.forename: Konstantinos E
authors.initials: KE
authors.lastname: Mandragos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016207:Cytokines / Q000096:biosynthesis; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage* / Q000627:therapeutic use; D007362:Intensive Care Units; D007963:Leukocytes, Mononuclear / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D016207:Cytokines; D005938:Glucocorticoids; D014662:Vasoconstrictor Agents; D006854:Hydrocortisone