Physicians Should Administer Low-Dose Corticosteroids Selectively to Septic Patients until an Ongoing Trial Is Completed
Authors: John M. Luce
Journal: Annals of Internal Medicine (2004)

Editorials6 July 2004Physicians Should Administer Low-Dose Corticosteroids Selectively to Septic Patients until an Ongoing Trial Is CompletedJohn M. Luce, MDJohn M. Luce, MDFrom University of California, San Francisco, San Francisco General Hospital.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-1-200407060-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Most physicians prefer administering therapies that have a physiologic rationale and proven benefit. We urgently need beneficial therapies for sepsis severe enough to cause shock, which is responsible for approximately 400 000 intensive care unit admissions and 200 000 deaths each year in the United States (1). In this issue, a meta-analysis by Minneci and colleagues (2) from the National Institutes of Health (NIH) concludes that low but not high doses of corticosteroids reduce mortality from septic shock and that we should administer these agents to all patients who have vasopressor-dependent sepsis. How the investigators reached these conclusions and why I agree ...References1. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303-10. [PMID: 11445675] CrossrefMedlineGoogle Scholar2. 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. LinkGoogle Scholar3. Cooper MS, Stewart PM. Corticosteroid insufficiency in acutely ill patients. N Engl J Med. 2003;348:727-34. 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[PMID: 8815944] CrossrefMedlineGoogle Scholar10. Rothwell PM, Udwadia ZF, Lawler PG. Cortisol response to corticotropin and survival in septic shock. Lancet. 1991;337:582-3. [PMID: 1671944] CrossrefMedlineGoogle Scholar11. Annane D, Bellissant E, Sebille V, Lesieur O, Mathieu B, Raphael JC, et al . Impaired pressor sensitivity to noradrenaline in septic shock patients with and without impaired adrenal function reserve. Br J Clin Pharmacol. 1998;46:589-97. [PMID: 9862249] CrossrefMedlineGoogle Scholar12. Annane D, Sébille V, Troché G, Raphaël JC, Gajdos P, Bellissant E. A 3-level prognostic classification in septic shock based on cortisol levels and cortisol response to corticotropin. JAMA. 2000;283:1038-45. [PMID: 10697064] CrossrefMedlineGoogle Scholar13. 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 Scholar14. Cooper MS, Stewart PM. Corticosteroid insufficiency in acutely ill patients. N Engl J Med. 2003;348:727-34. [PMID: 12594318] CrossrefMedlineGoogle Scholar15. Annane D, Bellissant E, Bollaert P, Briegel J, Keh D, Kupfer Y. Corticosteroids for treating severe sepsis and septic shock. Cochrane Database Syst Rev. 2004;1:CD002243. [PMID: 14973984] MedlineGoogle Scholar16. Annane D, Briegel J, Sprung CL. Corticosteroid insufficiency in acutely ill patients [Letter]. N Engl J Med. 2003;348:2157-9. [PMID: 12761380] CrossrefMedlineGoogle Scholar17. 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 InformationAuthors: John M. Luce, MDAffiliations: From University of California, San Francisco, San Francisco General Hospital.Disclosures: None disclosed.Current Author Address: John M. Luce, MD, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, 1001 Potrero Avenue, Room 5 K1, San Francisco, CA 94110; e-mail, john.[email protected]org. 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 Corticosteroids for Septic Shock Peter C. Minneci , Katherine J. Deans , Steven M. Banks , Peter Q. Eichacker , and Charles Natanson Dose Effects of Steroids on Survival in Sepsis David W. Noble Dose Effects of Steroids on Survival in Sepsis Robert G. Badgett Dose Effects of Steroids on Survival in Sepsis Katherine J. Deans , Charles Natanson , and Peter C. 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Noble, BMedBiol, MBChB, FRCADose Effects of Steroids on Survival in SepsisRobert G. Badgett, MDCorticosteroids for Septic ShockPeter C. Minneci, MD, Katherine J. Deans, MD, Steven M. Banks, PhD, Peter Q. Eichacker, MD, and Charles Natanson, MD 6 July 2004Volume 141, Issue 1Page: 70-72KeywordsAdrenocorticotropic hormoneCatecholaminesCorticosteroid therapyCortisolHospital medicineMortalityObservational studiesSepsisShockVasopressors ePublished: 6 July 2004 Issue Published: 6 July 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...