The Effects of High-Dose Corticosteroids in Patients with Septic Shock: A Prospective, Controlled Study

Charles L. Sprung, Panagiota V. Caralis, Eileen H. Marcial, Margaret Pierce, Mark A. Gelbard, William M. Long, Robert C. Duncan, Moses D. Tendler, Michael Karpf

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Abstract

To determine whether corticosteroids are efficacious in severe septic shock, we conducted a prospective study of 59 patients randomly assigned to a methylprednisolone, dexamethasone, or control group. Patients were treated 17.5 ± 5.4 hours (mean ± S.E.M.) after the onset of shock, and 55 patients required vasopressor agents. Early in the hospital course, reversal of shock was more likely in patients who received corticosteroids than in those who did not. Four (19 per cent) of 21 methylprednisolone-treated, 7 (32 per cent) of 22 dexamethasone-treated, and none of 16 control patients had reversal of shock 24 hours after drug administration (corticosteroid groups vs. control group, P < 0.05). Patients treated with corticosteroids within four hours after the onset of shock had a higher incidence of shock reversal (P < 0.05). At 133 hours after drug administration, 17 (40 per cent) of 43 corticosteroid-treated patients had died, and 11 (69 per cent) of 16 control patients had died (P < 0.05). However, these differences in reversal of shock and survival disappeared later in the course. Overall, 16 (76 per cent) of 22 patients receiving dexamethasone, and 11 (69 per cent) of 16 controls in the hospital died. We conclude that corticosteroids do not improve the overall survival of patients with severe, late septic shock but may be helpful early in the course and in certain subgroups of patients.

Original languageEnglish (US)
Pages (from-to)1137-1143
Number of pages7
JournalNew England Journal of Medicine
Volume311
Issue number18
DOIs
StatePublished - Nov 1 1984

ASJC Scopus subject areas

  • Medicine(all)

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    Sprung, C. L., Caralis, P. V., Marcial, E. H., Pierce, M., Gelbard, M. A., Long, W. M., Duncan, R. C., Tendler, M. D., & Karpf, M. (1984). The Effects of High-Dose Corticosteroids in Patients with Septic Shock: A Prospective, Controlled Study. New England Journal of Medicine, 311(18), 1137-1143. https://doi.org/10.1056/NEJM198411013111801