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      Hydrocortisone therapy for patients with septic shock

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      Sprung 2008.pdf (150.1Kb)
      Publication date
      10/01/2008
      Author
      Sprung, Charles L.
      Annane, Djillali
      Keh, Didier
      Moreno, Rui
      Singer, Mervyn
      Freivogel, Klaus
      Weiss, Yoram G.
      Benbenishy, Julie
      Kalenka, Armin
      Forst, Helmuth
      Laterre, Pierre-Francois
      Reinhart, Konrad
      Cuthbertson, Brian
      Payen, Didier
      Briegel, Josef
      CORTICUS Study Group
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      Abstract
      Background Hydrocortisone is widely used in patients with septic shock even though a survival benefit has been reported only in patients who remained hypotensive after fluid and vasopressor resuscitation and whose plasma cortisol levels did not rise appropriately after the administration of corticotropin. Methods In this multicenter, randomized, double-blind, placebo-controlled trial, we assigned 251 patients to receive 50 mg of intravenous hydrocortisone and 248 patients to receive placebo every 6 hours for 5 days; the dose was then tapered during a 6-day period. At 28 days, the primary outcome was death among patients who did not have a response to a corticotropin test. Results Of the 499 patients in the study, 233 (46.7%) did not have a response to corticotropin (125 in the hydrocortisone group and 108 in the placebo group). At 28 days, there was no significant difference in mortality between patients in the two study groups who did not have a response to corticotropin (39.2% in the hydrocortisone group and 36.1% in the placebo group, P=0.69) or between those who had a response to corticotropin (28.8% in the hydrocortisone group and 28.7% in the placebo group, P=1.00). At 28 days, 86 of 251 patients in the hydrocortisone group (34.3%) and 78 of 248 patients in the placebo group (31.5%) had died (P=0.51). In the hydrocortisone group, shock was reversed more quickly than in the placebo group. However, there were more episodes of superinfection, including new sepsis and septic shock. Conclusions Hydrocortisone did not improve survival or reversal of shock in patients with septic shock, either overall or in patients who did not have a response to corticotropin, although hydrocortisone hastened reversal of shock in patients in whom shock was reversed. (ClinicalTrials.gov number, NCT00147004 [ClinicalTrials.gov] .)
      Citation
      Sprung, C.L., Djillali, A., Keh, D., Moreno, R., Singer, M., Freivogel, K., Weiss, Y., Benbenishy, J., Kalenka, A., Forst, H., Laterre, P., Reinhart, K., Cuthbertson, B.H., Payen, D., and Briegel, J. (2008). Hydrocortisone therapy for patients with septic shock. New England Journal of Medicine, 358(2), pp. 111-124.
      URI
      http://hdl.handle.net/2164/274
      DOI
      http://dx.doi.org/10.1056/NEJMoa071366
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