Low-Dose Corticosteroids May Increase Mortality in Patients with Septic Shock

Low-dose corticosteroid treatment for septic shock has become widely accepted practice, largely on the basis of positive data from small, preliminary studies. However, neither the CORTICUS randomized trial (JW Infect Dis Jan 9 2008) nor data from recent sepsis registries have shown a survival benefit of corticosteroid treatment in patients with septic shock. We now have additional observational findings from the international, partly industry-funded Surviving Sepsis Campaign (SSC) registry, for which data were collected from January 2005 through March 2010 (JW Infect Dis Nov 25 2009).

Of 17,847 registry patients diagnosed with septic shock (i.e., who required vasopressor therapy), about half received low-dose corticosteroid treatment. Corticosteroids were significantly more likely to be used for septic shock in Europe and South America than in North America and, overall, to be given to patients with pneumonia and to patients on mechanical ventilation. Of the patients treated with corticosteroid therapy, 54% received it within 8 hours after onset of septic shock and 88% within 24 hours (i.e., mostly in line with guideline recommendations).

The adjusted odds ratio for in-hospital mortality was significantly higher among patients who received corticosteroid therapy than among those who did not (OR, 1.18; 95% confidence interval, 1.09–1.26). The finding persisted whether or not corticosteroid treatment was administered within 8 hours and regardless of mechanical-ventilation use, the presence of multiorgan failure, and the timing of patient enrollment in the registry (SSC low-dose corticosteroid treatment guidelines for septic shock were changed in 2008).