Early Administration of Hydrocortisone Replacement After the Advent of Septic Shock: Impact on Survival and Immune Response

Katsenos, Chrysostomos S. et  al on behalf of the Hellenic Sepsis Study Group

Critical Care Medicine:

July 2014 - Volume 42 - Issue 7 - p 1651–1657

Over a 2-year period, 170 patients with septic shock treated with low doses of hydrocortisone were enrolled. Blood was sampled from 34 patients for isolation of peripheral blood mononuclear cells and cytokine stimulation before and 24 hours after the start of hydrocortisone.

 After adjusting for disease severity and type of infection, a protective effect of early hydrocortisone administration against unfavorable outcome was found (hazard ratio, 0.20; p = 0.012).

Time of discontinuation of vasopressors was earlier among patients with initiation of hydrocortisone within 9 hours. Production of tumor necrosis factor-α was lower among patients who had had hydrocortisone early,

This resulted in improved survival.

Procalcitonin as a predictor of sepsis and outcome in severe trauma patients: a prospective study.

Rajkumari N, Mathur P, Sharma S, Gupta B, Bhoi S, Misra MC

J Lab Physicians. 2013 Jul;5(2):100-8.

Patients with high initial PCT levels (>2 ng/ml) in severe trauma cases had poor outcomes and risk of developing complications. Its correlation with severe outcomes was better marked as compared with CRP and ESR levels. The difference in PCT levels between days 1 and 4 in group two patients was statistically significant (P = 0.006) but were not statistically significant for CRP (P = 0.646) and ESR (P = 0.935). The study also shows that PCT levels fall in response to appropriate antimicrobial treatment.

Etomidate – a review of robust evidence for its use in various clinical scenarios   G. ERDOES et al

Acta Anaesthesiologica Scandinavica

Volume 58, Issue 4, pages 380–389, April 2014

Etomidate-induced transient adrenocortical suppression is well documented and has been associated with increased mortality in sepsis. In surgical patients at risk of hypotensive complications, however, a review of current literature provides no robust evidence to contraindicate a single-bolus etomidate induction