research
The effect of physiologic dose of intravenous
hydrocortisone in patients with refractory septic
shock: a randomized control trial
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Abstract
Objective: Septic shock is a response to infection and tissue hypoperfusion which does not
respond to fluid therapy and eventually leads to organ dysfunction. Aggressive treatment
of a broad-spectrum antimicrobial and supportive measures are the cornerstones of
successful treatment. In addition to the main treatment, there are adjunctive therapies.
Steroids are one of the treatments which have been studied in the management of
refractory septic shock. Despite numerous studies on the role of steroids in the mortality
of severe sepsis and septic shock, still lots of controversies exist. These conflicts are often
about the steroid dose and duration of administration.
Methods: This was a prospective, randomized-controlled, two-group assignment study.
Patients referred to Imam Reza (AS) hospital in Mashhad who had refractory septic shock
criteria were randomly divided into two groups: 80 patients were included in each group.
After obtaining the baseline cortisol level and cosyntropin test, one group was treated
with intravenous hydrocortisone, and the other group was treated with placebo. The
response to hydrocortisone, the return of shock duration, and mortality at 28 days were
investigated. The data were analyzed using SPSS version 16. For the normally distributed
variables, a t test was used for comparisons. Concerning qualitative variables, the chisquare
test or Fisher exact test were applied accordingly.
Results: The return of shock duration and mortality in intervention group patients was
more than control group, but it was not statistically significant.
Conclusion: Despite numerous studies in this field, there are various outcomes (mortality
rate, rate of return of shock, time of return of shock). These differences can be attributed
to high degree of heterogeneity. Perhaps considering the underlying disease and more
differentiation could change the return of shock and mortality rate.
Keywords: Hydrocortisone, Septic shock, Adrenal insufficiency, Cortiso