Erschienen in:
10.08.2021 | Editorial
Transcriptional markers in response to hydrocortisone in sepsis in ADRENAL: a step toward precision medicine
verfasst von:
Timothy E. Sweeney, Hector R. Wong
Erschienen in:
Intensive Care Medicine
|
Ausgabe 9/2021
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Excerpt
Practice varies widely for corticosteroid usage in sepsis [
1], perhaps because study results have themselves varied widely, leading to a minor recommendation within the SSC guidelines for patients in refractory shock. Still, a recent Cochrane review of 61 trials with over 12,000 participants suggests a modest but significant benefit in terms of 28-day mortality along with reduced ICU and hospital length of stay [
2]. So why does practice continue to vary? Individual study results vary; the climax of this scientific dilemma occurred 2018 when two independent large RCT were published in the same issue of NEJM with contradictory results (APROCCHSS and ADRENAL; the studies also had differences in severity of illness and steroid dosing). The largest study of these, ADRENAL (
N = 3658), showed no mortality benefit with corticosteroids, but shorter time in shock and on mechanical ventilation [
3]. In addition, there are negative side effects; the same Cochrane review showed increased rates of hypernatremia and hyperglycemia with corticosteroid usage. …
