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Many experts recommend low-to-moderate-dose corticosteroid therapy in patients with septic shock who respond poorly to stimulation with adrenocorticotropic hormone (ACTH; e.g., cosyntropin). This recommendation is based largely on results of a single placebo-controlled trial published in 2002 (Journal Watch Aug 30 2002), in which steroid therapy lowered short-term mortality from 63% to 53% (P=0.04) in cosyntropin nonresponders. Now, investigators have conducted another multicenter trial — the CORTICUS study.
Researchers randomized 499 adults with septic shock (onset within 72 hours) to receive 11-day courses of either hydrocortisone (50 mg intravenously every 6 hours for 5 days, followed by tapering dose) or placebo. All patients underwent 6…