Do Steroids Improve Clinically Relevant Outcomes in Patients with Septic Shock?

Sepsis is a dysregulated host response to infection that may progress to septic shock, a state of global hypoperfusion that often requires fluid resuscitation and vasopressors to support adequate oxygen delivery. Septic shock results in both macro- and microcirculatory failure, which ultimately progresses to multi-organ dysfunction and potentially death.1,2 Depending on the patient population, mortality for septic shock can exceed 50%. Relative adrenal insufficiency can be seen in up to 60% of patients with septic shock.

Steroids with glucocorticoid and mineralocorticoid effects (e.g., hydrocortisone) have been given to patients with sepsis since the 1950s.3-8 In the 1980s, studies that evaluated the administration of supraphysiologic doses of steroids (i.e., 30 mg/kg methylprednisolone) to patients with severe sepsis failed to demonstrate clinical benefit.9 As a result of these studies, the administration of high-dose steroids to patients with septic shock is currently not recommended. More recent studies have evaluated the administration of physiologic doses of steroids to patients with septic shock.

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