Corticosteroids in sepsis and septic shock: has the jury reached a verdict?

Mortality from septic shock remains high, despite early diagnosis, comprehensive care and monitoring, and intensive therapy. The use of high-dose corticosteroids as adjunctive therapy in septic states has been extensively debated in the literature, but no clear consensus has been reached. Main sites of action where corticosteroids can theoretically interfere with the pathophysiologic processes activated by sepsis have been identified. Early clinical studies and extensive animal research generated much enthusiasm for the use of steroids in sepsis and septic shock. Recently, however, well-designed clinical studies have consistently failed to show a beneficial effect of corticosteroid use in septic states. After re-examining the theoretical basis for the use of steroids, possible side effects, experimental results and clinical trials, it is concluded that, based upon current knowledge, high-dose corticosteroids should not be used as adjunctive therapy in human sepsis and septic shock.