ADRENAL - Hydrocortisone In Septic Shock

Spoon Feed
There was no difference in 90-day mortality among critically ill, intubated patients with septic shock who received hydrocortisone 200mg IV daily and those who did not.  Shock resolved one day faster in the steroid group.

Why does this matter?
The debate over steroid use for septic shock has been going on for decades.  Studies have been back and forth.  This is one of the largest and appears to be definitive.

Finally - It doesn't work
This was a very large multi-center RCT with 3800 medical and surgical patients with septic shock who were intubated.  There were about 1800 per group who were assessed for the primary outcome, death at 90 days.  Groups were well matched.  Those who received etomidate were excluded.  They found no difference in mortality at 90 days or 28 days.  Multiple secondary outcomes were measured as well, with only resolution of shock in 3 vs 4 days and 10 vs 12 days in the ICU being superior in the steroid group.  No subgroup seemed to benefit.  There were more adverse events in the hydrocortisone group, such as hyperglycemia, hypernatremia, myopathy, encephalopathy, etc.  Routine use of supplemental hydrocortisone for septic shock was not beneficial and had an increased risk of harmful side effects.

Source
Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. N Engl J Med. 2018 Jan 19. doi: 10.1056/NEJMoa1705835. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.

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