Hydrocortisone Doesn’t Seem to Lower Risk for Septic Shock in Adults with Sepsis

Edited by David G. Fairchild, MD, MPH

Low-dose hydrocortisone infusion may not prevent progression to septic shock among adults with severe sepsis, according to a JAMA study.

Some 380 adults with severe sepsis who were not in septic shock were randomized to receive placebo or hydrocortisone (an initial 50-mg intravenous bolus, followed by a 200-mg continuous infusion daily for 5 days, then dose tapering until day 11). The primary outcome — the proportion of patients with septic shock within 14 days — did not differ significantly between the groups (21.2% with hydrocortisone vs. 22.9% with placebo). In addition, the groups did not differ significantly in terms of length of stay or mortality through 180 days.

Hyperglycemia was more common with hydrocortisone than with placebo (90.9% vs. 81.5%).

Editorialists note that “concrete recommendations regarding the use of corticosteroids in sepsis … remain difficult.” However, the current study “suggests no role for glucocorticoids for prevention of shock, at least among patients similar to those in this trial.”