The Effects of Moderate-dose Steroid Therapy in Sepsis: A Placebo-controlled, Randomized Study

Overview

Journal J Res Med Sci

Specialty General Medicine

Date 2012 Sep 14

PMID 22973341

Citations 12

Authors

Orhan Yildiz

Fatih Tanriverdi

Serap Simsek

Bilgehan Aygen

Fahrettin Kelestimur

Affiliations

Soon will be listed here.

Abstract

Background: Despite the new developments in sepsis treatment, mortality rate is still high. In this study, we aimed to investigate endocrinologic changes and the effects of moderate dosage steroid treatment in patients with sepsis.

Methods: Fifty-five patients were included in the study. Basal hormonal evaluation and adrenocorticotropin hormone (ACTH) stimulation test were performed within 24 h in all patients. Both groups received standard treatment for sepsis. However, one group (steroid group) was also given intravenous prednisolone (20 mg/day). All-cause mortality was assessed during the first 28 days.

Results: Analysis of the findings revealed a 59.3% mortality rate in steroid group compared with a 53.6% mortality rate in placebo group (p = 0.787). Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores, and peak cortisol and ACTH levels were significant factors related to mortality. The incidence of adrenal insufficiency (AI) was 10.9% and relative adrenal insufficiency (RAI) 36.4%. It was also found that steroid treatment did not have any effects on the mortality of patients with AI and RAI (p = 0.075 and p = 0.999, respectively).

Conclusions: Moderate-dose steroid therapy has no effect on mortality. Higher basal cortisol and peak cortisol levels were found more reliable mortality indicators compared to RAI. In addition, the study revealed that ACTH level was a significant indicator of mortality.

Citing Articles

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Effect of adjunctive vitamin C, glucocorticoids, and vitamin B1 on longer-term mortality in adults with sepsis or septic shock: a systematic review and a component network meta-analysis.

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Corticosteroids for Treating Sepsis in Adult Patients: A Systematic Review and Meta-Analysis.

Liang H, Song H, Zhai R, Song G, Li H, Ding X Front Immunol. 2021; 12:709155.

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New Evidence of Potential Benefits of Dexamethasone and Added on Therapy of Fludrocortisone on Clinical Outcomes of Corticosteroid in Sepsis Patients: A Systematic Review and Meta-Analysis.

Son J, Shin S, Choi Y J Pers Med. 2021; 11(6).

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The Efficacy, Safety, and Optimal Regimen of Corticosteroids in Sepsis: A Bayesian Network Meta-Analysis.

Zhang S, Chang W, Xie J, Wu Z, Yang Y, Qiu H Crit Care Explor. 2020; 2(4):e0094.

PMID: 32426736 PMC: 7188436. DOI: 10.1097/CCE.0000000000000094.

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