Adjunctive Glucocorticoid Therapy in Patients with Septic Shock
| Autor: | Marc Ziegenfuss, Jewel Barlow-Armstrong, Kelly Thompson, Manoj Saxena, Yaseen Arabi, Jeffrey Presneill, Sharon Micallef, John Myburgh, Severine Bompoint, Simon Finfer, Serena Knowles, Christopher Joyce, Andrew Rhodes, Dorrilyn Rajbhandari, Martin Madsen, Bala Venkatesh, Parisa Glass, Jeremy COHEN, Laurent Billot, Christina Whitehead, Anders Perner, Tony Whitehouse |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Hydrocortisone medicine.medical_treatment Anti-Inflammatory Agents Bacteremia Placebo Artificial respiration law.invention 03 medical and health sciences 0302 clinical medicine Double-Blind Method Recurrence Interquartile range law medicine Humans 030212 general & internal medicine Infusions Intravenous Survival rate APACHE Aged Mechanical ventilation Septic shock business.industry Hazard ratio 030208 emergency & critical care medicine General Medicine Middle Aged medicine.disease Respiration Artificial Shock Septic Intensive care unit Renal Replacement Therapy Survival Rate Treatment Outcome Chemotherapy Adjuvant Anesthesia Female business Fungemia |
| Zdroj: | New England Journal of Medicine. 378:797-808 |
| ISSN: | 1533-4406 0028-4793 |
| Popis: | Background Whether hydrocortisone reduces mortality among patients with septic shock is unclear. Methods We randomly assigned patients with septic shock who were undergoing mechanical ventilation to receive hydrocortisone (at a dose of 200 mg per day) or placebo for 7 days or until death or discharge from the intensive care unit (ICU), whichever came first. The primary outcome was death from any cause at 90 days. Results From March 2013 through April 2017, a total of 3800 patients underwent randomization. Status with respect to the primary outcome was ascertained in 3658 patients (1832 of whom had been assigned to the hydrocortisone group and 1826 to the placebo group). At 90 days, 511 patients (27.9%) in the hydrocortisone group and 526 (28.8%) in the placebo group had died (odds ratio, 0.95; 95% confidence interval [CI], 0.82 to 1.10; P=0.50). The effect of the trial regimen was similar in six prespecified subgroups. Patients who had been assigned to receive hydrocortisone had faster resolution of shock than those assigned to the placebo group (median duration, 3 days [interquartile range, 2 to 5] vs. 4 days [interquartile range, 2 to 9]; hazard ratio, 1.32; 95% CI, 1.23 to 1.41; P |
| Databáze: | OpenAIRE |
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