• Prosanto Chaudhury, John C Marshall, Joseph S Solomkin, and Members of the Evidence Based Reviews in Surgery Group.
• Mount Sinai Hospital, 60 Murray St., Toronto, Ontario.
• Can J Surg. 2010 Dec 1;53(6):415-7.

ObjectiveTo evaluate the efficacy and safety of low-dose hydrocortisone therapy in patients with septic shock.DesignMulticentre, randomized, double-blind, placebo-controlled trial.SettingNine centres (including 52 intensive care units) in Europe and the Middle East.PatientsPatients with clinical evidence of infection, evidence of systemic response to infection and onset of shock within the previous 72 hours (defined by systolic blood pressure < 90 mm Hg despite adequate fluid replacement or a need for vasopressors for at least 1 hour) and hypoperfusion or organ dysfunction attributable to sepsis.InterventionINTERVENTION group (n = 251) was randomly assigned to receive 50 mg of hydrocortisone intravenously, and the control group (n = 248) was randomly assigned to receive placebo every 6 hours for 5 days; the dose was tapered during a 6-day period.Main Outcome MeasureDeath at 28 days in patients who did not have a response to corticotrophin.ResultsIn all, 233 (46.7%) patients did not have a response to corticotrophin (125 in the treatment group and 108 in the placebo group). At 28 days, there was no significant difference in mortality between patients in the 2 groups who did not have a response to corticotropin (39.2% in the treatment group and 36.1% in the placebo group, p = 0.69) or between those who had a response to corticotropin (28.8% in the treatment group and 28.7% in the placebo group, p = 1.00). At 28 days, 86 of 251 (34.3%) patients in the treatment group and 78 of 248 (31.5%) in the placebo group had died (p = 0.51). In the treatment group, shock was reversed more quickly than in the placebo group. However, there were more episodes of superinfection, including new sepsis and septic shock.ConclusionHydrocortisone cannot be recommended as general adjuvant therapy for septic shock (vasopressor responsive), nor can corticotrophin testing be recommended to determine which patients should receive hydrocortisone therapy.

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