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Title: Hydrocortisone therapy for patients with septic shock
Authors: Sprung, Charles L.
Annane, Djillali
Keh, Didier
Moreno, Rui
Singer, Mervyn
Freivogel, Klaus
Weiss, Yoram G.
Benbenishy, Julie
Kalenka, Armin
Forst, Helmuth
Laterre, Pierre-Francois
Reinhart, Konrad
Cuthbertson, Brian
Payen, Didier
Briegel, Josef
CORTICUS Study Group
University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences
Keywords: Anti-inflammatory Agents
Hydrocortisone
Shock, Septic
Issue Date: 10-Jan-2008
Publisher: Massachusetts Medical Society.
Citation: Sprung, C.L., Djillali, A., Keh, D., Moreno, R., Singer, M., Freivogel, K., Weiss, Y., Benbenishy, J., Kalenka, A., Forst, H., Laterre, P., Reinhart, K., Cuthbertson, B.H., Payen, D., and Briegel, J. (2008). Hydrocortisone therapy for patients with septic shock. New England Journal of Medicine, 358(2), pp. 111-124.
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 [ClinicalTrials.gov] .)
URI: http://hdl.handle.net/2164/274
DOI: http://dx.doi.org/10.1056/NEJMoa071366
ISSN: 0028-4793
Appears in Collections:Applied Health Sciences research
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