Summaries for Patients |

Low Doses of Steroids Improve Survival in Patients with Septic Shock FREE

[+] Article, Author, and Disclosure Information

The summary below is from the full report titled “Meta-Analysis: The Effect of Steroids on Survival and Shock during Sepsis Depends on the Dose.” It is in the 6 July 2004 issue of Annals of Internal Medicine (volume 141, pages 47-56). The authors are P.C. Minneci, K.J. Deans, S.M. Banks, P.Q. Eichacker, and C. Natanson.

Ann Intern Med. 2004;141(1):I-64. doi:10.7326/0003-4819-141-1-200407060-00006
Text Size: A A A

What is the problem and what is known about it so far?

Septic shock is a serious, sometimes fatal, condition that occurs when an overwhelming infection leads to low blood pressure and low blood flow. Doctors have tried several treatments for septic shock. From 1960 to 1990, they sometimes gave people with septic shock infusions of high-dose steroids (glucocorticoids) to try to fight inflammation and help increase blood pressure. Some studies suggested that the high doses actually worsened the body's ability to fight infection. Since 1990, doctors sometimes used lower doses of steroids. Whether the lower doses actually benefit patients is not clear.

Why did the researchers do this particular study?

To determine whether steroids given in particular doses improve survival rates of patients with septic shock.

Who was studied?

1717 patients with sepsis and septic shock who had participated in trials that assessed effects of steroids on survival.

How was the study done?

Rather than performing a new study, the researchers reviewed 14 trials. These trials randomly assigned adult patients with sepsis in intensive care units to receive or not receive infusions of steroids. Nine trials were performed between 1960 and 1990 and 5 trials were performed between 1998 and 2002. The researchers assessed doses and timing of steroids used in the trials. They then compared how many patients survived in the 2 groups of studies.

What did the researchers find?

Trials published before 1990 showed that steroids worsened survival of patients with sepsis. Recent trials showed that steroids improved survival. The recent trials gave steroids in lower doses and for longer periods (about a week) than the earlier trials (several hours to days). Older trials more often started steroid therapy within a few hours of diagnosis, while recent trials more often started steroid therapy 1 to 3 days after diagnosis.

What were the limitations of the study?

Patients with septic shock typically receive several treatments. Treatments other than steroids may have varied between older and newer studies.

What are the implications of the study?

Short courses of high-dose steroids harm patients with sepsis, while 5- to 7-day courses of low-dose steroids benefit patients with sepsis.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.