Steroids and Sepsis: Time for Another Reevaluation

Treatment of sepsis has changed little in the past few decades and the lack of improvement is reflected in the relatively steady mortality rate. Much of the initial disappointment surrounding many of the past multicentered clinical trials in sepsis centers on the use of short-term, high-dose steroids. While recent advances focusing on the interplay between inflammation and coagulation are expected to result in important new treatments in sepsis, rekindled enthusiasm for the role of supraphysiologic-dose steroids is adding to the excitement. Specifically, emerging evidence suggests that moderate-dose glucocorticoids may improve outcomes in septic shock patients, in part, by treating occult adrenal insufficiency. One preliminary study that has sparked considerable interest reported a 30% relative reduction in mortality in sepsis patients treated with modest doses of hydrocortisone for 1 week. It appears clear the role of adrenal insufficiency and steroids in septic shock is deserving of a reevaluation.