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Time course of organ failure in patients with septic shock treated with hydrocortisone: results of the Corticus study



Corticosteroids have been proposed to decrease morbidity and mortality in patients with septic shock. An impact on morbidity should be anticipated to be earlier and more easily detected than the impact on mortality.


Prospective, randomized, double-blind, placebo-controlled study of 28-day mortality in patients with septic shock for <72 h who underwent a short high-dose ACTH test in 52 centers in 9 European countries. Patients received 11-day treatment with hydrocortisone or placebo. Organ dysfunction/failure was quantified by the use of the sequential organ failure assessment (SOFA) score.


From March 2002 to November 2005, 499 patients were enrolled (hydrocortisone 251, placebo 248). Both groups presented a similar SOFA score at baseline (hydrocortisone 10.8 ± 3.2 vs. placebo 10.7 ± 3.1 points). There was no difference in 28-day mortality between the two treatment groups (hydrocortisone 34.3% vs. placebo 31.5%). There was a decrease in the SOFA score of hydrocortisone-treated patients from day 0 to day 7 compared to the placebo-treated patients (p = 0.0027), driven by an improvement in cardiovascular organ dysfunction/failure (p = 0.0005) and in liver failure (p < 0.0001) in the hydrocortisone-treated patients.


Patients randomized to treatment with hydrocortisone demonstrated a faster decrease in total organ dysfunction/failure determined by the SOFA score, primarily driven by a faster improvement in cardiovascular organ dysfunction/failure. This organ dysfunction/failure improvement was not accompanied by a decreased mortality.

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The CORTICUS study was supported by the European Commission contract QLK2-CT-2000-00589, the European Society of Intensive Care Medicine (ESICM), the International Sepsis Forum (ISF) and the Gorham Foundation. Roche Diagnostics GmbH, Mannheim/Penzberg, Germany, provided the Elecsys® Cortisol immunoassay. The EU Commission and other sponsors had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; or in the preparation, review or approval of the manuscript. Thanks also to Prof. Dr. Wolfgang Hartl for suggestions that greatly improved the quality of the manuscript.

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Correspondence to R. Moreno.

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On behalf of the CORTICUS investigators

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Supplementary material 1 (DOC 539 kb)



Steering Committee: C. Sprung (Chairman); D. Annane; J. Briegel; D. Keh; R. Moreno; D. Pittet; M. Singer; Y. Weiss.

Safety and Efficacy Monitoring Committee: J. Cohen (Chairman); C. Dore; T. Evans; N. Soni, F. Sorenson (Analytica International).

Study Coordinating Center: C. Sprung (Physician Coordinator); J. Benbenishty (Nurse Coordinator); A. Avidan, E. Ludmir; J. Kabiri; K. Furmanov; B. Hain; O. Kalugin; I. Zack.

Clinical Evaluation Committee: Y Weiss (Chairman); D. Annane; J. Briegel; S. Goodman; D. Keh; R. Moreno; M. Singer; C. Sprung

Berlin Coordinating Center: D. Keh (Chairman); A. Goessinger.

French Coordinating Center: D. Annane (Chairman); N. Zinsou, D. Friedman.

Munich Central Laboratory Harmonization: J. Briegel (Chairman); M. Vogeser.

Statistical Analyses: Analytica International- F. Sorenson, K. Freivogel.

CORTICUS Investigators: Austria: LKH Feldkirch, Feldkirch (P. Fae); Krankenhaus Barmherzige Schwestern, Linz (J. Reisinger); Universitaetsklinik fuer Innere Medizin II, Wien (G. Heinz); Belgium: Hopital St. Joseph, Arlon (M. Simon); Department of Critical Care Medicine, St Luc University Hospital, UCL, Brussels (P–F. Laterre, X. Wittebole, MN France); University Hospital Erasme, Université de Bruxelles, Brussels (J.L. Vincent, D. DeBacker); CHU Charleroi, Charleroi (P. Biston). France: Hopital de Caen, Caen (C. Daubin); Hopital Raymond Poincare, Garches (D. Annane, D. Lipiner, V. Maxime); Hopital Huriez, Lille (PA. Rodie Talbere, B. Vallet); Hopital Caremeau, Nimes (J.Y. Lefrant); Hopital Saint-Antoine, Paris (G. Offenstadt); Hopital Lariboisiere, Paris (D. Payen, A.C. Lukaszewicz). Germany: Zentralklinikum Augsburg, Augsburg (H. Forst, G. Neeser, Y. Barth); Charite Universitaetsmedizin Berlin, Campus Virchow-Klinikum (D. Keh, J.Langrehr, M.Oppert, C.Spies), Campus Mitte (C. Spies, S.Rosseau), Campus Benjamin Franklin (J. Weimann); Evangelisches Waldkrankenhaus Spandau, Berlin (M. Reyle Hahn); St. Joseph-Krankenhaus, Berlin (M. Schmutzler); Vivantes Klinikum Spandau, Berlin (K.J. Slama), Vivantes Klinikum Neukoelln, Berlin (H.Gerlach), Vivantes Klinikum im Friedrichshain,Berlin (S. Veit); Inst. For Anaesthesia & Operative Intensive Care Medicine, Darmstadt (M. Welte, L. Von Beck); University Hospital Carl Gustav Carus, Dresden (C. Marx); Krankenhaus Hennigsdorf, Hennigsdorf (A. Lange); Friedrich-Schiller Universitaet, Jena (K. Reinhart, F. Bloos, F. Brunkhorst); Klinikum Kempten-Oberallgaeu, Kempten (M. Haller); Klinikum of Landshut, Landshut (U. Helms); Klinikum Mannheim, Mannheim (A. Kalenka, F. Fiedler); Universitaetsklinikum Marburg, Marburg (M. Max); Klinik fuer Anaesthesiologie, Klinikum der Universitaet, Ludwig-Maximilians-Universitaet, Munich (J. Briegel); Department of Surgery, Klinikum der Universitaet-Grosshadern, Munich (W. Hartl); Staedtisches Krankenhaus Muenchen-Harlaching, Munich (M. Klimmer, T. Helmer); Universitaet Erlangen-Namberg, Nuernberg (M. Baumgaertel); Klinikum Ernst von Bergman, Potsdam (D. Pappert). Israel: Haemek Hospital, Afula (A. Lev); Hadassah Medical Organization, Jerusalem (Y. Weiss, C. Sprung, J. Benbenishty, O. Shatz); Belinson Medical Centre, Petach Tikva (P. Singer); Ichilov Hospital, Tel Aviv (A. Nimrod). Italy: Policlinico di Tor Vergata, Rome (S. Natoli); Centro di Rianimazione, Ospedale S. Eugenio, Rome (F. Turani). Netherlands: Erasmus University Medical Center, Rotterdam (B. Van der Hoven). Portugal: Hospital de St. Antonio do Capuchos, Lisbon (R. Moreno, R. Matos). United Kingdom: Aberdeen Royal Infirmary, Aberdeen (B.H. Cuthbertson, S. Roughton); The Ipswich Hospital NHS, Ipswich (M. Garfield); The General Infirmary at Leeds, Leeds (A. Mallick); University College London Hospitals NHS Foundation Trust, London (M. Singer, M McKendry); Southampton General Hospital, Southampton (T. Woodcock).

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Moreno, R., Sprung, C.L., Annane, D. et al. Time course of organ failure in patients with septic shock treated with hydrocortisone: results of the Corticus study. Intensive Care Med 37, 1765 (2011). https://doi.org/10.1007/s00134-011-2334-x

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  • Corticosteroids
  • Steroids
  • Hydrocortisone
  • Septic shock
  • Mortality
  • Organ dysfunction
  • Organ failure
  • Sequential Organ Failure Assessment score. SOFA