Peter C. Minneci, MD; Katherine J. Deans, MD; Steven M. Banks, PhD; Peter Q. Eichacker, MD; Charles Natanson, MD
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Minneci P., Deans K., Banks S., Eichacker P., Natanson C.; Corticosteroids for Septic Shock. Ann Intern Med. 2004;141:742-743. doi: 10.7326/0003-4819-141-9-200411020-00032
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Published: Ann Intern Med. 2004;141(9):742-743.
TO THE EDITOR:
The editorial by Dr. Luce (1) accompanying our meta-analysis examining clinical trials of low-dose steroid therapy in sepsis (2) raised concerns about our recommendation to administer low-dose glucocorticoids to all patients with vasopressor-dependent septic shock. Dr. Luce concluded that the results of the clinical sepsis trials of low-dose steroids support administering steroids only to patients with “proven adrenal insufficiency” (1). As cited by Dr. Luce, a recent report by Hamrahian and colleagues (3) demonstrated that in critically ill patients, variations in total serum cortisol measurements may be explained by differences in the concentration of serum binding proteins, and only free serum cortisol measurements accurately reflect adrenal function in these patients. In light of these findings, the division of patients into subgroups based on the results of corticotropin stimulation testing using total serum cortisol measurements may be inappropriate. Furthermore, these data support evaluating the overall effects of steroids in each of the clinical sepsis trials rather than focusing on subgroup analyses based on corticotropin stimulation tests using total serum cortisol measurements.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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