Does Adjunctive Steroid Tx Improve Outcomes in Patients With Septic Shock?

Patients who received hydrocortisone had a faster resolution of shock, which may have big implications for length of ICU stays
Patients who received hydrocortisone had a faster resolution of shock, which may have big implications for length of ICU stays

The use of adjunctive glucocorticoid therapy in patients with septic shock may reduce the duration of shock and the time spent on life support therapy in intensive care units (ICU). The findings comes from an international trial conducted in 3,800 patients, which was published in the New England Journal of Medicine.

While steroids have been used to treat septic shock for more than 40 years, uncertainty remains about the potential complications and the optimal dosing and duration of treatment. For this study, patients with septic shock who were undergoing mechanical ventilation were randomized to receive hydrocortisone (200mg daily) or placebo for 7 days or until death or discharge form the ICU.

The primary outcome of death from any cause at 90 days was ascertained in 3,658 of the patients. Death rates for the hydrocortisone group were not significantly lower than the placebo group; a total of 511 patients (27.9%) in the hydrocortisone group died compared to 526 (28.8%) in the placebo group (odds ratio, 0.85; 85% CI, 0.82 to 1.10; P=0.50). 

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However, those who received hydrocortisone had faster resolution of shock with a median duration of 3 days compared to 4 days for the placebo group (HR, 1.32; 95% CI, 1.23 to 1.41; P<0.001). Time to intensive care unit discharge was also shorter for the hydrocortisone group, with a mean discharge after 10 days compared to 12 for the placebo group (HR, 1.14; 95% CI, 1.06 to 1.23; P<0.001).

"If we can reduce the time in spent in intensive care units that not only frees up space for other patients, it saves health systems worldwide a huge amount of money,” said Bala Venkatesh, of The George Institute for Global Health and lead author of the study.

The hemodynamic effects of hydrocortisone were similar to that of previous studies, leading the authors to believe these effects may “represent a beneficial role of hydrocortisone.” The authors conclude by stating that a detailed cost-benefit analysis would help inform clinicians about the overall cost-effectiveness of hydrocortisone in patients with septic shock.

For more information visit nejm.org.