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

  • Author Footnotes
    1 These authors contributed equally to the study and they should be regarded as joint first authors.
    Qing-quan Lv
    Footnotes
    1 These authors contributed equally to the study and they should be regarded as joint first authors.
    Affiliations
    Department of Critical Care Medicine, Subei People's Hospital, Clinical Medical School of Yangzhou University, Yangzhou, China
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  • Author Footnotes
    1 These authors contributed equally to the study and they should be regarded as joint first authors.
    Xiao-hua Gu
    Footnotes
    1 These authors contributed equally to the study and they should be regarded as joint first authors.
    Affiliations
    Department of Critical Care Medicine, Subei People's Hospital, Clinical Medical School of Yangzhou University, Yangzhou, China
    Search for articles by this author
  • Qi-hong Chen
    Affiliations
    Department of Critical Care Medicine, Subei People's Hospital, Clinical Medical School of Yangzhou University, Yangzhou, China
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  • Jiang-quan Yu
    Affiliations
    Department of Critical Care Medicine, Subei People's Hospital, Clinical Medical School of Yangzhou University, Yangzhou, China
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  • Rui-qiang Zheng
    Correspondence
    Corresponding author at: Department of Critical Care Medicine, Subei People's Hospital, Clinical Medical School of Yangzhou University, 98 West Nantong Road, 225001 Yangzhou, China.
    Affiliations
    Department of Critical Care Medicine, Subei People's Hospital, Clinical Medical School of Yangzhou University, Yangzhou, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to the study and they should be regarded as joint first authors.

      Abstract

      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.
      Trial registration: www.clinicaltrials.gov NCT02580240.

      Keywords

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