Should Patients with Sepsis Receive Glucocorticoids?

Should patients with sepsis receive glucocorticoids? Debate continues because two recent, large randomized trials have yielded conflicting results (NEJM JW Gen Med Apr 15 2018 and N Engl J Med 2018; 378:809; NEJM JW Gen Med Mar 1 2018 and N Engl J Med 2018; 378:797). Most studies have shown more rapid reversal of shock with glucocorticoid administration, but questions remains about whether treatment lowers short-term mortality in specific populations.

Investigators conducted a patient-level meta-analysis of 17 trials that involved more than 7800 patients with sepsis or septic shock who were treated with as much as 400 mg of hydrocortisone daily for at least 72 hours. Patients treated with hydrocortisone or placebo had similar 90-day mortalit…