The Article: Hydrocortisone Therapy for Patients with Septic Shock (aka CORTICUS). Sprung et al. (2008) New Engl. J. Med. 358(2):111-124.
The Idea: Whether administration of hydrocortisone would improve survival or reverse shock in patients with septic shock.
The Study: Randomized, double-blind, placebo-controlled trial of 499 patients suffering from septic shock in 52 ICUs around the globe. Patients received hydrocortisone therapy (29 doses over 11 days) or placebo and were determined to be adrenally insufficient or sufficient based on a short corticoptropin stim test. Primary end points were mortality at 28 days for those who did not respond to corticotropin. Secondary endpoints were 28 day mortality for all patients, mortality during ICU or hospital stay or 1 year out, reversal of shock and LOS.
The Findings: There was no significant difference in 28 day mortality between the corticotropin insensitive patients who received steroids or placebo. There was also no difference in 28 day mortality among the corticoptropin sensitive patients or in any patients at any time point. Hydrocortisone therapy did reverse shock sooner in all patients but also led to an increased incidents of adverse events including superinfections.
The Takeaway: Hydrocortisone therapy can’t be recommended as an adjunctive therapy in patients suffering from septic shock and corticotropin testing cannot be used to determine which patients would benefit from hydrocortisone therapy.