重度のセプシス患者のショック発症に対するヒドロコルチゾンの効果: HYPRESSランダム化臨床試験
Didier Keh1, Evelyn Trips2, Gernot Marx3
1Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.
JAMA
|October 4, 2016
まとめ
ヒドロコルチゾンは,重症のセプシス患者において,セプシスショックを予防しなかった. この研究では,ヒドロコルチゾンとプラセボのグループ間のセプティックショックの発症や死亡率に有意な違いが見出されず,この患者集団での使用が疑問視されました.
科学分野:
- クリティカル ケア 医療
- 薬理学について
- 感染症
背景:
- セプシスの生存キャンペーンでは 耐火性セプシスショックでヒドロコルチゾンを推奨しています
- しかし,ショックなしでの重症性セプシスの有効性は議論されています.
研究 の 目的:
- ヒドロコルチゾンの投与が重症性毒症の患者で毒性ショックへの進行を防ぐことができるかどうかを調査する.
主な方法:
- ダブルブラインド ランダム化臨床試験で 380人の成人患者に 重度のセプシスがあったが ショックはなかった
- 患者は,継続的なヒドロコルチゾン注入 (5日間200mg/日,その後は徐々に) またはプラセボを受けた.
- 主なアウトカムは14日以内に結血性ショックの発症でした.
主要な成果:
- ヒドロコルチゾン群の21. 2%とプラセボ群の22. 9%でセプティックショックが発生した (P=0. 70).
- セプティックショックまでの時間,ICUまたは病院での死亡率,または180日生存率は有意な差異は見られなかった.
- 感染症,離乳不全,筋肉の弱さ,高血糖症などの二次的なアウトカムも有意な群差を示さなかった.
結論:
- ヒドロコルチゾン治療は,重度のセプシスを持つ成人のセプティックショック発症のリスクを低下させなかった.
- ショック状態でない重症のセプシス患者では,ヒドロコルチゾンの使用は支持されません.
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