Steroids in Sepsis: The Fog Is Beginning to Lift

The steroids for sepsis story dates back to 1959 and remains unsettled. Results from a meta-analysis of nine randomized studies that were published before 1989 demonstrated that steroids had no benefit in septic shock. In these early studies, steroid doses ranged from high to massive (e.g., 120 mg/kg of methylprednisolone per day). In the early 1990s, researchers found that 40% of patients had "inadequate" adrenal responses to sepsis; this condition is known as relative adrenal insufficiency.

Now, researchers have performed a meta-analysis of five randomized, controlled studies published after 1997 in which steroids were administered in physiologic doses (95% lower than doses in the earlier studies). Overall survival was significantly increa…