Annane 2002

JAMA

August 21, 2002

Effect of Treatment With Low Doses of Hydrocortisone and Fludrocortisone on Mortality in Patients With Septic Shock

Summarized by: 

Mazen Kherallah

What was the research question?

  • In critically ill patients with septic shock, does hydrocortisone combined with fludrocortisone improve 29-day mortality compared to placebo?


How did they do it?

  • A multicenter, randomized, double-blind, parallel-group trial in France

  • 300 patients with septic shock were randomized to receive either hydrocortisone (50-mg intravenous bolus every 6 hours) and fludrocortisone (50-µg tablet once daily) (n = 151) or matching placebos (n = 149) for 7 days.

  • All patients had corticotropin stimulation test and were calssified as responders (cortisol level increased more than 9 mcg/dL) or non-responders (cortisol level increase was less than 9 mcg/dL).

  • The primary outcome was 28-day mortality.


What did they find?

  • There were 229 non-responders to the corticotropin test (placebo, 115; corticosteroids, 114) and 70 responders to the corticotropin test (placebo, 34; corticosteroids, 36).

  • Among non-responders, 28-day mortality was lower in the hydrocortisone group compared to the placebo (53% vs. 63%, P = .02).

  • Vasopressor therapy was withdrawn within 28 days at a higher rate in the hydrocortisone group compared to the placebo group (57% vs. 40%, P = .001).

  • Steroid therapy reduced the median day of vasopressor therapy (9 vs. 7 days, p=0.01).

  • There was no significant difference between groups in responders. Adverse events rates were similar in the 2 groups.


What does it mean?

  • Hydrocortisone in a combination of fludrocortisone improved 28-day mortality and reduced vasopressor needs in septic shock patients.

  • Please review more recent studies as the CORITCUS study revealed that hydrocortisone does not improve survival but hastened the reversal of shock and No need to do the corticotropin stimulation test.

Annane 2002