Study Questions Value of Glucocorticoids for Sepsis

Hydrocortisone is nonsuperior to placebo in reducing rates of 90-day mortality among intensive care unit (ICU) patients with septic shock undergoing mechanical ventilation, a recent study showed.

For their study, the researchers identified 3800 patients with septic shock who underwent mechanical ventilation. From March 2013, to April 2017, 3658 of 3800 patients were randomly assigned to receive either 200 mg/day hydrocortisone (n=1832) or placebo (n=1826) for 7 days or until death or discharge from the ICU.
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Findings from the study indicated that, ultimately, the hydrocortisone group did not have lower rates of 90-day mortality vs placebo. At 90 days, a total of 511 (27.9%) patients on hydrocortisone and 526 (28.8%) on placebo had died.

Fewer patients on hydrocortisone received a blood transfusion vs those on placebo (37.0% vs 41.7%). Patients on hydrocortisone had a faster resolution of shock (median duration: 3 days vs. 4 days) and a shorter duration of initial mechanical ventilation vs those on placebo (median duration: 6 days vs. 7 days).

However, following adjustment for episodes of recurrence of ventilation, there were no significant differences in the number of days alive and free from mechanical ventilation.

The researchers observed no significant between-group differences in 28-day mortality, the rate of recurrence of shock, and various other factors.

“Among patients with septic shock undergoing mechanical ventilation, a continuous infusion of hydrocortisone did not result in lower 90-day mortality than placebo,” the researchers concluded.

—Christina Vogt

Reference:

Venkatesh B, Finfer S, Cohen J, et al; ADRENAL Trial Investigators and the Australian-New Zealand Intensive Care Society Clinical Trials Group. Adjunctive glucocorticoid therapy in patients with septic shock [Published online January 19, 2018]. N Eng J Med. doi:10.1056/NEJMoa1705835.