LOW-DOSE HYDROCORTISONE INFUSION ATTENUATES THE SYSTEMIC INFLAMMATORYRESPONSE SYNDROME

There is increasing evidence that the hypercortisolemia in inflammator y diseases suppresses the elaboration of proinflammatory cytokines, th us protecting the host from its own defence reactions. In severe sepsi s and septic shock cortisol levels are usually elevated, but some pati ents may have relative adrenal insufficiency. This may contribute to t he overwhelming systemic inflammatory response syndrome. We evaluated the impact of low-dose hydrocortisone infusion (10 mg/h) on the course of the systemic inflammatory response syndrome. This dose corresponds to a maximum secretory rate of cortisol achieved in corticotropin-sti mulated healthy humans. In a prospective observational study 57 surgic al patients with severe sepsis or septic shock were studied, of which in addition to the conventional treatment 12 patients were infused wit h low-dose hydrocortisone, and 45 were treated without any corticoster oid. In the longitudinal analysis the systemic inflammatory response - as judged by body temperature, cardiovascular response, and kinetics of inflammatory mediators such as phospholipase A(2), C-reactive prote in, and neutrophil elastase - started to differ in favor of the hydroc ortisone-treated patients after 2 days of treatment (P < 0.05, Mann-Wh itney U test). The difference disappeared after withdrawal of exogenou s cortisol. Shock reversal was achieved in all patients treated with l ow-dose hydrocortisone. The data provide evidence that low-dose hydroc ortisone infusion attenuates the systemic inflammatory response in hum an septic shock. From an immunological point of view a relative cortis ol deficiency may contribute to the amplified immune response in syste mic inflammatory diseases, A randomized clinical trial must clarify th e impact of low-dose hydrocortisone infusion on the clinical course an d outcome of septic shock patients.