No Benefit to Steroids in Septic Shock
Another common treatment, intensive insulin therapy, may be harmful
WEDNESDAY, Jan. 9 (HealthDay News) -- New data challenges common practices in the treatment of septic shock: intensive insulin therapy does not improve outcomes compared to conventional insulin therapy, but increases the likelihood of severe hypoglycemic events, and treatment with hydrocortisone is no better than placebo, even among corticotropin non-responders, according to two articles published in the Jan. 10 issue of the New England Journal of Medicine.
Frank M. Brunkhorst, M.D., of Friedrich Schiller University in Jena, Germany, and colleagues randomized 537 patients in a two-by-two design to receive intensive or conventional insulin therapy and fluid resuscitation with 10 percent pentastarch solution or modified Ringer's lactate. Intensive insulin therapy increased the rates of severe hypoglycemia and serious adverse events compared to conventional insulin, while pentastarch led to more acute renal failure and need for dialysis compared to Ringer's lactate. The trial was halted early due to these safety concerns.
In a second study, Charles L. Sprung, M.D., of Hadassah Hebrew University Medical Center in Jerusalem, Israel, and colleagues randomized 499 patients with septic shock to receive five days of intravenous hydrocortisone followed by a six-day taper, or placebo. Hydrocortisone treatment did not improve survival, regardless of the results of a corticotropin stimulation test. Though hydrocortisone decreased the duration of shock, it also increased the likelihood of superinfection, including new sepsis, compared to placebo.
"On the basis of these findings, hydrocortisone cannot be recommended as general adjuvant therapy for septic shock (vasopressor responsive), nor can corticotropin testing be recommended to determine which patients should receive hydrocortisone therapy," Sprung and colleagues conclude.
The first study was funded by B. Braun, HemoCue, and Novo Nordisk. Authors from both studies report financial ties from the pharmaceutical industry.