Background and objectives Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine that plays a major role in the pathogenesis of sepsis. The goal of this study was to determine the effect of exogenous glucocorticoid treatment on MIF expression.

Design and setting: Prospective, randomized, double-blinded, interventional single-center study.

Methods Thirty patients with septic shock were prospectively randomized to receive 3 doses of 0.2 mg/kg of dexamethasone (Intervention group) or equal doses of saline (Placebo group). Sequential Organ Failure Assessment (SOFA) and Pediatric Logistic Organ Dysfunction (PELOD) scores were recorded daily in both groups. Seven and 28-day Mortality were recorded as early and late endpoints of the study. Baseline and follow-up levels of MIF were measured by ELISA for all enrolled subjects.

Results Mean baseline MIF values were 86±17, 82±21, 10.8±5 ng/mL for Intervention, Placebo and control subjects respectively; p<0.001. Follow up MIF showed significant reduction in both patients groups compared to baseline levels, with more significant reduction in Intervention group (23% reduction) compared to Placebo group (13% reduction); p<0.01. SOFA score showed significant worsening in Placebo group; compared to Intervention group. PELOD score showed significant increase in Intervention group compared to highly significant worsening in Placebo group. Seven-day mortality was significantly higher in Placebo group (53.3%) compared to Intervention group (20%); while 28-day mortality showed insignificant change.

Conclusions Early treatment with dexamethasone lead to more significant reduction in MIF levels than placebo, with less worsening of organ dysfunction and improved seven-day mortality with no effect on 28-day mortality.