Hydrocortisone therapy for patients with septic shock

Area of Science:

• Critical Care Medicine
• Endocrinology
• Pharmacology

Background:

• Hydrocortisone is frequently used for septic shock, despite evidence suggesting survival benefits are limited to specific patient subgroups.
• Patients with septic shock who remain hypotensive despite fluid and vasopressor resuscitation, and exhibit inadequate cortisol response to corticotropin, are often candidates for hydrocortisone therapy.

Purpose of the Study:

• To evaluate the efficacy of intravenous hydrocortisone in improving survival in patients with septic shock.
• To determine if hydrocortisone benefits patients with septic shock and adrenal insufficiency, defined by non-response to corticotropin stimulation.

Main Methods:

• A multicenter, randomized, double-blind, placebo-controlled trial involving 499 patients with septic shock.
• Patients received either intravenous hydrocortisone (50 mg every 6 hours for 5 days, followed by tapering) or a placebo.
• The primary outcome was 28-day mortality, specifically analyzing subgroups based on response to a corticotropin test.

Main Results:

• No significant difference in 28-day mortality was observed between the hydrocortisone and placebo groups, overall or within subgroups of patients who did or did not respond to corticotropin.
• Hydrocortisone treatment led to a faster reversal of shock compared to placebo.
• However, the hydrocortisone group experienced a higher incidence of superinfections, including new cases of sepsis and septic shock.

Conclusions:

• Hydrocortisone administration did not improve overall survival in patients with septic shock.
• The treatment did not enhance survival in patients with adrenal insufficiency (non-responders to corticotropin).
• While hydrocortisone accelerated shock reversal, the increased risk of superinfections raises concerns about its net benefit in septic shock management.