Dose Effects of Steroids on Survival in Sepsis
Authors: Robert G. Badgett
Journal: Annals of Internal Medicine (2004)

Letters7 December 2004Dose Effects of Steroids on Survival in SepsisRobert G. Badgett, MDRobert G. Badgett, MDFrom University of Texas Health Science Center at San Antonio, San Antonio, TX 78229.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-11-200412070-00026 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The meta-analysis of corticosteroids for septic shock by Minneci and colleagues (1) is an important synthesis of this difficult topic. Could the authors please comment on the following 2 observations?First, the meta-analysis led to conflicting opinions between the authors and the editorialist (2) about the safety and efficacy of continuing corticosteroids among patients with normal adrenal response to corticotropin stimulation testing (“responders”). Close examination of the authors' Table 3 shows significant heterogeneity in the mortality data among the responders (I2 = 58%) (3). The 3 studies mentioned in Table 3 should not be pooled, either mathematically ...References1. Minneci PC, Deans KJ, Banks SM, Eichacker PQ, Natanson C. Meta-analysis: the effect of steroids on survival and shock during sepsis depends on the dose. Ann Intern Med. 2004;141:47-56. [PMID: 15238370] LinkGoogle Scholar2. Luce JM. Physicians should administer low-dose corticosteroids selectively to septic patients until an ongoing trial is completed [Editorial]. Ann Intern Med. 2004;141:70-2. [PMID: 15238374] LinkGoogle Scholar3. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557-60. [PMID: 12958120] CrossrefMedlineGoogle Scholar4. Annane D, Sébille V, Charpentier C, Bollaert PE, François B, Korach JM, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002;288:862-71. [PMID: 12186604] CrossrefMedlineGoogle Scholar5. Yildiz O, Doganay M, Aygen B, Güven M, Keleûtimur F, Tutuû A. Physiological-dose steroid therapy in sepsis [ISRCTN36253388]. Crit Care. 2002;6:251-9. [PMID: 12133187] CrossrefMedlineGoogle Scholar6. Bollaert PE, Charpentier C, Levy B, Debouverie M, Audibert G, Larcan A. Reversal of late septic shock with supraphysiologic doses of hydrocortisone. Crit Care Med. 1998;26:645-50. [PMID: 9559600] CrossrefMedlineGoogle Scholar7. Hamrahian AH, Oseni TS, Arafah BM. Measurements of serum free cortisol in critically ill patients. N Engl J Med. 2004;350:1629-38. [PMID: 15084695] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Texas Health Science Center at San Antonio, San Antonio, TX 78229. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMeta-Analysis: The Effect of Steroids on Survival and Shock during Sepsis Depends on the Dose Peter C. Minneci , Katherine J. Deans , Steven M. Banks , Peter Q. Eichacker , and Charles Natanson Physicians Should Administer Low-Dose Corticosteroids Selectively to Septic Patients until an Ongoing Trial Is Completed John M. Luce Dose Effects of Steroids on Survival in Sepsis Katherine J. Deans , Charles Natanson , and Peter C. Minneci Dose Effects of Steroids on Survival in Sepsis David W. Noble Metrics 7 December 2004Volume 141, Issue 11Page: 891-892KeywordsAdrenocorticotropic hormoneCortisolFludrocortisoneMortalitySafetySepsisShockSteroids ePublished: 7 December 2004 Issue Published: 7 December 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...