Hydrocortisone does not improve survival in septic shock
Severe sepsis is a major cause of mortality and morbidity worldwide. Septic shock, the most severe manifestation, results in death rates of up to 60 percent. The use of corticosteroids to compensate a deficit of the classic stress hormone cortisol has been controversial for decades. Lower doses of cortisol or the structurally identical hydrocortisone, respectively, is widely understood to lead to an earlier reversal of shock and improved survival. Even though the survival benefit has only been proven in a subgroup of patients, hydrocortisone is used in all cases of septic shock. Professor Josef Briegel at the Clinic of Anaesthesiology of Ludwig-Maximilians-Universität (LMU) München and an international team of researchers have now completed a multi-centre study to analyze the effects of hydrocortisone. As reported in the recent edition of the research journal The New England Journal of Medicine, the results are rather sobering. “Hydrocortisone didn’t improve survival overall, although it did hasten reversal of shock,” says Briegel. “This lack of benefit may be related to an increased incidence of new septic episodes. On the basis of our findings, hydrocortisone can’t be recommended as a general adjuvant therapy for septic shock.”
“Hydrocortisone Therapy for Patients with Septic Shock”,
Charles L. Sprung, M.D., Djillali Annane, M.D., Ph.D., Didier Keh, M.D., Rui Moreno, M.D., Mervyn Singer, M.D., F.R.C.P., Klaus Freivogel, Ph.D., Yoram G. Weiss, M.D., Julie Benbenishty, R.N., Armin Kalenka, M.D., Helmuth Forst, M.D., Ph.D., Pierre-Francois Laterre, M.D., Konrad Reinhart, M.D., Brian H. Cuthbertson, M.D., Didier Payen, M.D., Ph.D., and Josef Briegel, M.D., Ph.D.
New England Journal of Medicine (NEJM), January 10, 2008
Professor Dr. Josef Briegel
Clinic of Anaesthesiology of LMU Munich
Tel.: +49-89-7095-789 1131