Table 1

 Randomised controlled trials testing the use of steroids in low dose for septic shock

CitationStudy groupStudy typeOutcomeKey resultsComments
Annane et al (2002)2300 adults with dopamine resistant septic shock divided according to the increase in cortisol in response to short corticotropin test (250 μg) as responders (>9 μg/dl) or non-responders (<9 μg/dl)Randomised controlled trial (hydrocortisone 200 mg/day + fludrocortisone 50 μg/day v placebo, for 7 days)28 day survival Time to vasopressor withdraw28 day mortality of (steroids v placebo) 60/114 v 73/115 in the non-responders and 22/36 v 18/34 for responders–adjusted Odds ratios of 0.54 (0.31–0.97) and 0.97(0.32–2.97), respectively Time to withdraw vasopressor was (steroids v placebo) 7 v 10 days in non-responders (HR of 1.91 (1.29–2.84)) and 9 v 7 days in responders (p = 0.49)Very specific population Large confidence intervals, upper limit close to 1 Do not report incidence of hyperglycaemia associated with steroids Number of patients needed to treat to save 1 additional life is 7 (4–49)
Bollaert et al (1998)441 adults with septic shock requiring catecholamine for more than 48 hours Response to corticotrophin stimulation test (increase >6 μg/dl)Randomised controlled trial (300 mg/day hydrocortisone v placebo, for >5 days)7 day reversal of shock 28 day mortality7 day reversal of shock (15/22 v 4/19, p = 0.007) Mortality (7/22 v 12/19, p = 0.45) Similar improve (7 d, 28 m) in responder and non-responderDiscontinued early because primary end point was achieved Late inclusion of patients Large confidence intervals (7 day reversal of shock 17 to 77%) Other clinical interventions were not described
Yildiz et al (2002)340 adults with sepsisRandomised controlled trial (prednisolone (7.5 mg/day, for 10 days)28 day mortality8/20 steroid and 12/20 placebo (p = 0.34) Higher difference in APACHE II>20 (not calculated)Only 9 (22%) shocked Small sample No power calculation Trend for improve in survival, specially in the more severe group