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| Efficacy of hydrocortisone in the management of septic shock-insight into two randomized controlled trials published in New England Journal of Medicine |
| Zhou Zhe, Wang Li-jun |
| Department of Critical Care Medicine, the Affiliated Bao′an Hospital of Shenzhen, the Second School of Clinical Medicine, Southern Medical University, Shenzhen 518101, China |
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Abstract Sepsis is a syndrome of life-threatening organ dysfunction due to a dysregulated host response to infection and septic shock is the most critical subtype with high mortality. The effective measure is lacking except early recognition, infection source control, appropriate antibiotic therapy, fluid resuscitation and vasopressor support. Great efforts have long been made to seek alternative more effective approaches to manage this ancient disease, and a lot of randomize clinical trials to assess the efficacy of low dose glucocorticoid therapy have been made, and controversies and conflicts still exist. In early of 2018, two large random control trials, the ADRENAL trial and APROCCHSS trial, which brought opposite results were published in the New England Journal of Medicine (NEJM) to explored the efficacy of glucocorticoids in patients with septic shock, and still draw great concerns. The ADRENAL study showed that the 90-day all-cause mortality could not be improved, while the APROCCHSS study, on the other hand, reduced the relative risk of death by 12%. However, both studies have shown that glucocorticoids can shorten the duration of shock and reduce the intensity of organ support. With the use of “omics” techniques including gene, transcription, and inflammation to find subtypes of septic patients who benefit from immune-modulation therapy is the future direction.
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Corresponding Authors:
Wang Li-jun, E-mail: wanglj63@163.com
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