Hydrocortisone therapy for patients with septic shock. Export

@article{citeulike:2247754, abstract = {BACKGROUND: Hydrocortisone is widely used in patients with septic shock even though a survival benefit has been reported only in patients who remained hypotensive after fluid and vasopressor resuscitation and whose plasma cortisol levels did not rise appropriately after the administration of corticotropin. METHODS: In this multicenter, randomized, double-blind, placebo-controlled trial, we assigned 251 patients to receive 50 mg of intravenous hydrocortisone and 248 patients to receive placebo every 6 hours for 5 days; the dose was then tapered during a 6-day period. At 28 days, the primary outcome was death among patients who did not have a response to a corticotropin test. RESULTS: Of the 499 patients in the study, 233 (46.7\%) did not have a response to corticotropin (125 in the hydrocortisone group and 108 in the placebo group). At 28 days, there was no significant difference in mortality between patients in the two study groups who did not have a response to corticotropin (39.2\% in the hydrocortisone group and 36.1\% in the placebo group, P=0.69) or between those who had a response to corticotropin (28.8\% in the hydrocortisone group and 28.7\% in the placebo group, P=1.00). At 28 days, 86 of 251 patients in the hydrocortisone group (34.3\%) and 78 of 248 patients in the placebo group (31.5\%) had died (P=0.51). In the hydrocortisone group, shock was reversed more quickly than in the placebo group. However, there were more episodes of superinfection, including new sepsis and septic shock. CONCLUSIONS: Hydrocortisone did not improve survival or reversal of shock in patients with septic shock, either overall or in patients who did not have a response to corticotropin, although hydrocortisone hastened reversal of shock in patients in whom shock was reversed. (ClinicalTrials.gov number, NCT00147004.)}, address = {Hadassah Hebrew University Medical Center, Jerusalem, Israel 91120. sprung@cc.huji.ac.il}, author = {Sprung, C. L. and Annane, D. and Keh, D. and Moreno, R. and Singer, M. and Freivogel, K. and Weiss, Y. G. and Benbenishty, J. and Kalenka, A. and Forst, H. and Laterre, P. F. and Reinhart, K. and Cuthbertson, B. H. and Payen, D. and Briegel, J. and {}}, citeulike-article-id = {2247754}, citeulike-linkout-0 = {http://dx.doi.org/10.1056/NEJMoa071366}, citeulike-linkout-1 = {http://content.nejm.org/cgi/content/abstract/358/2/111}, citeulike-linkout-2 = {http://view.ncbi.nlm.nih.gov/pubmed/18184957}, citeulike-linkout-3 = {http://www.hubmed.org/display.cgi?uids=18184957}, day = {10}, doi = {10.1056/NEJMoa071366}, issn = {1533-4406}, journal = {N Engl J Med}, keywords = {choc\_septique, reanimation}, month = {January}, number = {2}, pages = {111--124}, posted-at = {2008-03-15 16:29:40}, priority = {2}, title = {Hydrocortisone therapy for patients with septic shock.}, url = {http://dx.doi.org/10.1056/NEJMoa071366}, volume = {358}, year = {2008} }

TY - JOUR ID - citeulike:2247754 L3 - citeulike-article-id:2247754 N2 - BACKGROUND: Hydrocortisone is widely used in patients with septic shock even though a survival benefit has been reported only in patients who remained hypotensive after fluid and vasopressor resuscitation and whose plasma cortisol levels did not rise appropriately after the administration of corticotropin. METHODS: In this multicenter, randomized, double-blind, placebo-controlled trial, we assigned 251 patients to receive 50 mg of intravenous hydrocortisone and 248 patients to receive placebo every 6 hours for 5 days; the dose was then tapered during a 6-day period. At 28 days, the primary outcome was death among patients who did not have a response to a corticotropin test. RESULTS: Of the 499 patients in the study, 233 (46.7%) did not have a response to corticotropin (125 in the hydrocortisone group and 108 in the placebo group). At 28 days, there was no significant difference in mortality between patients in the two study groups who did not have a response to corticotropin (39.2% in the hydrocortisone group and 36.1% in the placebo group, P=0.69) or between those who had a response to corticotropin (28.8% in the hydrocortisone group and 28.7% in the placebo group, P=1.00). At 28 days, 86 of 251 patients in the hydrocortisone group (34.3%) and 78 of 248 patients in the placebo group (31.5%) had died (P=0.51). In the hydrocortisone group, shock was reversed more quickly than in the placebo group. However, there were more episodes of superinfection, including new sepsis and septic shock. CONCLUSIONS: Hydrocortisone did not improve survival or reversal of shock in patients with septic shock, either overall or in patients who did not have a response to corticotropin, although hydrocortisone hastened reversal of shock in patients in whom shock was reversed. (ClinicalTrials.gov number, NCT00147004.) IS - 2 JF - N Engl J Med SN - 1533-4406 AD - Hadassah Hebrew University Medical Center, Jerusalem, Israel 91120. sprung@cc.huji.ac.il EP - 124 TI - Hydrocortisone therapy for patients with septic shock. VL - 358 SP - 111 KW - choc_septique KW - reanimation AU - Sprung, CL AU - Annane, D AU - Keh, D AU - Moreno, R AU - Singer, M AU - Freivogel, K AU - Weiss, YG AU - Benbenishty, J AU - Kalenka, A AU - Forst, H AU - Laterre, PF AU - Reinhart, K AU - Cuthbertson, BH AU - Payen, D AU - Briegel, J PY - 2008/01/10/ UR - http://dx.doi.org/10.1056/NEJMoa071366 ER -