Early initiation of low-dose hydrocortisone treatment for septic shock in adults: A randomized clinical trial

Background: Physiologic dose hydrocortisone is part of the suggested adjuvant therapies for patients with septic shock. However, the association between the corticosteroid therapy and mortality in patients with septic shock is still not clear. Some authors considered that the mortality is related to the time frame between development of septic shock and start of low dose hydrocortisone. Thus we designed a placebo-controlled, randomized clinical trial to assess the importance of early initiation of low dose hydrocortisone for the final outcome. Methods: A total of 118 patients with septic shock were recruited in the study. All eligible patients were randomized to receive hydrocortisone (n = 58) or normal saline (n = 60). The study medication (hydrocortisone and normal saline) was initiated simultaneously with vasopressors. The primary end-point was 28-day mortality. The secondary end-points were the reversal of shock, in-hospital mortality and the duration of ICU and hospital stay. Results: The proportion of patients with reversal of shock was similar in the two groups (P = 0.602); There were no significant differences in 28-day or hospital all-cause mortality; length of stay in the ICU or hospital between patients treated with hydrocortisone or normal saline. Conclusion: The early initiation of low-dose of hydrocortisone did not decrease the risk of mortality, and the length of stay in the ICU or hospital in adults with septic shock. (C) 2017 Elsevier Inc. All rights reserved.