Low Doses of Steroids Improve Survival in Patients with Septic Shock

Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.

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.

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.