Steroids beneficial in refractory septic shock
Preface: This multi-center observational study of over 1,800 patients examined whether low-dose steroids (<80 mg prednisone equivalents) was superior to placebo for patients in septic shock. There results showed that there was a slight decrease in 30-day mortality (50.6% vs 55.8%) for those patients in the highest APACHE II quartile if they received steroids vs placebo.
There was no benefit to steroid use in patients less sick.
This study supports the most recent 2013 Surviving Sepsis Guidelines (Crit Care Med 2013; 41:580) that recommend steroids for septic shock that persists despite volume resuscitation and high-dose vasopressors.
Funk D et al. Low-dose corticosteroid treatment in septic shock: A propensity-matching study. Crit Care Med 2014 Nov; 42:2333.