The Journal of Informed Pharmacotherapy 2002;11:150.
Reviewer: James McCormack, B.Sc. (Pharm), Pharm. D.
Reviewer's email address: firstname.lastname@example.org
Reviewer's profession/specialty: Associate Editor, Journal of Informed Pharmacotherapy
Annane D, Sébille V, Charpentier C, Bollaert P, François B, Korach J, Capellier G, Cohen Y, Azoulay E, Troché G, Chaumet-Riffaut P, Bellissant E. Effect of Treatment With Low Doses of Hydrocortisone and Fludrocortisone on Mortality in Patients With Septic Shock. JAMA 2002;288:862-71 PubMed Citation
These investigators assessed whether low doses of corticosteroids could reduce mortality when given to patients with septic shock. The main endpoint was the 28-day survival in patients with relative adrenal insufficiency.
299 patients fulfilling the criteria for septic shock. Their average age was 61 and approximately 34% were female.
Patients were randomized to receive either placebo or hydrocortisone 50 mg IV every 6 hours plus fludrocortisone 50 mcg daily for 7 days. All patients received a corticotropin test to identify relative adrenal insufficiency. Relative adrenal insufficiency (non-responders) was defined by a response of 9 mcg/dL or less.
The duration of follow up was 28 days.
* p = 0.09, ** p = 0.06
NR= non responders/relative adrenal insufficiency, R = responders to corticotropin test, NSS = not statistically significant
Adverse events rates were similar for each group.
This study suggests that corticosteroids given to patients with septic shock and adrenal insufficiency decreases 28-day and ICU mortality.
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