Low doses of steroids cut septic shock mortalityDr. Djillali Annane said at the 12th International Congress on Infectious Diseases that a consensus has emerged that corticosteroids provide major benefits in patients with severe sepsis or septic shock.

Dr. Annane of the University of Versailles, France, said these benefits only with low doses of corticosteroids administered for at least 5 days, and only in the sizable patient subsets having adrenal insufficiency or refractory septic shock.

From Internalmedicinenews.com:

Much of the lengthy controversy in this field was the result of great heterogeneity in clinical trials, particularly those done before 1992. For example, steroids for septic shock fell into disfavor all through the 1980s and 1990s because multiple trials before 1992 showed no benefit. That’s because these negative studies used short-course, high-dose corticosteroids, Dr. Annane explained. Today, with the benefit of hindsight, it can be emphatically stated that no evidence supports the use of such therapy, he said at the congress, which was sponsored by the International Society for Infectious Diseases.

Dr. Annane was first author of a 2006 Cochrane Collaboration systematic review of corticosteroids for treatment of severe sepsis and septic shock (Cochrane Library ISSN 1464-780X).

In 15 randomized trials totaling more than 2,000 children and adults included in the analysis, steroid therapy didn’t change 28-day all-cause mortality. But the results varied with dosing strategy. In nine trials of replacement-dose corticosteroids—the equivalent of hydrocortisone at 200–300 mg/day intravenously for 5 days or longer—there was a highly significant 20% reduction in the relative risk of 28-day mortality compared with placebo, along with a greater proportion of patients experiencing shock reversal by day 7. In contrast, patients on high-dose, short-course corticosteroids didn’t benefit.

The benefits, as shown in multiple randomized placebo-controlled trials, are enhanced 28-day mortality, shorter shock duration, improved hemodynamics, reduced organ dysfunction, and less systemic inflammation.