Low-dose hydrocortisone treatment for patients with septic shock: A pilot study comparing 3 days with 7 days

Background and objective: Although there is controversy regarding the benefit of low-dose corticosteroid therapy in patients with septic shock, the Surviving Sepsis Campaign has advocated that low-dose intravenous hydrocortisone be used to treat adult septic shock patients. This study investigated the effect of the duration of a stress dose of hydrocortisone on survival of septic shock patients with relative adrenal insufficiency. Methods: One hundred and thirty consecutive patients who met the American College of Chest Physicians/Society of Critical Care Medicine criteria for septic shock were included in the study. An additional inclusion criterion was vasopressor support after fluid resuscitation. The primary end-point was 28-day mortality, and the secondary end-points were shock reversal and mortality in the intensive care unit and hospital. All eligible patients were prospectively randomized to receive hydrocortisone treatment for 3 or 7 days. Hydrocortisone treatment was started at a dose of 50 mg every 6 h. Results: Baseline data at recruitment did not differ between the two groups. After 28 days, mortality did not differ between the 3- and 7-day treatment groups (33.8% vs 36.9%, P = 0.629). Mortality rates in the intensive care unit and hospital did not differ significantly between the two groups. The median time to withdrawal of vasopressor therapy was 5.0 days in the 3-day treatment group and 6.4 days in the 7-day treatment group (P = 0.102). Conclusions: This pilot study showed that in patients with septic shock and relative adrenal insufficiency, 28-day mortality did not differ between those treated with low-dose hydrocortisone for 3 or 7 days.