Critical Care

, 15:446 | Cite as

Glucocorticoids in sepsis: dissecting facts from fiction

  • Charles L Sprung
  • Djillali Annane
  • Mervyn Singer
  • Rui Moreno
  • Didier Keh
  • the CORTICUS Study Group
Letter

Keywords

Hydrocortisone Norepinephrine Glucocorticoid Septic Shock Organ Dysfunction 

Dr Marik's recent commentary [1] states that "..as a result of an overwhelming selection bias, only approximately 5% of eligible patients were enrolled in the CORTICUS study [2]." As its authors, we are unaware as to what constitutes this overwhelming bias and from where he has plucked a figure of 5%. CORTICUS enrolled patients with clinical evidence of infection, systemic inflammatory response syndrome, shock within 72 hours (defined by a systolic blood pressure <90 mmHg despite adequate fluid replacement OR need for vasopressors for ≥1 hour), and hypoperfusion or organ dysfunction attributable to sepsis [2]. The placebo group received a maximum norepinephrine dose of 0.4 ± 0.5 mcg/kg/minute and their 28-day mortality was 31.5%. We openly acknowledged that slow recruitment was partly related to loss of equipoise; however, the above data not only appear representative of real life practice but are comparable to other contemporary septic shock studies, for example, VASST [3]. His contention that 7 to 10 days of low-dose hydrocortisone should be considered in patients receiving norepinephrine or equivalent at doses >0.1 mcg/kg/minute within 12 hours of shock onset is not supported by any evidence base, contradicts presently accepted international recommendations [4] and portrays a far more striking example of bias.

Notes

References

  1. 1.
    Marik PE: Glucocorticoids in sepsis: dissecting facts from fiction. Crit Care 2011, 15: 158. 10.1186/cc10101PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Sprung CL, Annane D, Keh D, Moreno R, Singer M, Freivogel K, Weiss YG, Benbenishty J, Kalenka A, Forst H, Laterre PF, Reinhart K, Cuthbertson BH, Payen D, Briegel J: Hydrocortisone therapy for patients with septic shock. N Engl J Med 2008, 358: 111-124. 10.1056/NEJMoa071366CrossRefPubMedGoogle Scholar
  3. 3.
    Russell JA, Walley KR, Singer J, Gordon AC, Hebert PC, Cooper J, Holmes CL, Mehta S, Granton JT, Storms MM, Cook DJ, Presneill JJ, Ayers D, for the VASST Investigators: Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med 2008, 358: 877-887. 10.1056/NEJMoa067373CrossRefPubMedGoogle Scholar
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    Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL, International Surviving Sepsis Campaign Guidelines Committee; American Association of Critical-Care Nurses; American College of Chest Physicians; American College of Emergency Physicians; Canadian Critical Care Society; European Society of Clinical Microbiology and Infectious Diseases, et al.: Surviving Sepsis Campaign: International guidelines for the management of severe sepsis and septic shock: 2008. Crit Care Med 2008, 36: 296-327. 10.1097/01.CCM.0000298158.12101.41CrossRefPubMedGoogle Scholar

Copyright information

© BioMed Central Ltd 2011

Authors and Affiliations

  • Charles L Sprung
    • 1
  • Djillali Annane
    • 2
  • Mervyn Singer
    • 3
  • Rui Moreno
    • 4
  • Didier Keh
    • 5
  • the CORTICUS Study Group
  1. 1.Hadassah Hebrew University Medical CenterJerusalemIsrael
  2. 2.Raymond Poincaré Hospital (Assistance Publique-Hôpitaux de Paris)GarchesFrance
  3. 3.University College LondonLondonUK
  4. 4.UCIP, Hospital de St António dis CapuchosCentro Hospitalar de Lisboa Central, E.P.ELisbonPortugal
  5. 5.CharitéUniversitaetsmedizinBerlinGermany

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