Corticosteroid Treatment Improves Adult Sepsis Outcomes

In all, 37 randomized clinical trials (RCTs) that met inclusion criteria were used to compare administration of corticosteroids with placebo or standard supportive care in 9,564 adult patients with sepsis.

The results revealed that corticosteroid use was associated with reduced 28-day mortality, intensive care unit (ICU) mortality, and in-hospital mortality. Corticosteroids were also significantly associated with increased shock reversal at day seven, vasopressor-free days, ICU length of stay, sequential organ failure assessment score at day seven, and time to resolution of shock. But corticosteroid use was also associated with increased risk of hyperglycemia and hypernatremia. The study was published on December 21, 2018, in JAMA Internal Medicine.

“Corticosteroids have been used as adjuvant therapy for sepsis for more than 50 years without hard evidence to guide patient selection. Physicians have used their clinical judgment to decide how to use corticosteroids,” concluded lead author Chao You, MD, of Sichuan University, and colleagues. “These findings appear to indicate that corticosteroids should be prescribed at a low dose and for a long course. Future studies are needed to associate personalized medicine with clinical phenotyping, genotyping, or metabolomics with the treatment of sepsis.”

Sepsis is characterized by a whole-body inflammatory state caused by the immune system's response to a serious infection, most commonly bacteria, but also fungi, viruses, and parasites in the blood, urinary tract, lungs, skin, or other tissues. Symptoms of sepsis include those related to a specific infection, and are usually accompanied by high fevers, hot, flushed skin, elevated heart rate, hyperventilation, altered mental status, swelling, and low blood pressure. Sepsis causes millions of deaths globally each year.

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Sichuan University
Southwest Hospital of Army Medical University