Published in:
01-10-2011 | Letter
Glucocorticoids in sepsis: dissecting facts from fiction
Authors:
Charles L Sprung, Djillali Annane, Mervyn Singer, Rui Moreno, Didier Keh, the CORTICUS Study Group
Published in:
Critical Care
|
Issue 5/2011
Login to get access
Excerpt
Dr Marik's recent commentary [
1] states that "..as a result of an overwhelming selection bias, only approximately 5% of eligible patients were enrolled in the CORTICUS study [
2]." As its authors, we are unaware as to what constitutes this overwhelming bias and from where he has plucked a figure of 5%. CORTICUS enrolled patients with clinical evidence of infection, systemic inflammatory response syndrome, shock within 72 hours (defined by a systolic blood pressure <90 mmHg despite adequate fluid replacement OR need for vasopressors for ≥1 hour), and hypoperfusion or organ dysfunction attributable to sepsis [
2]. The placebo group received a maximum norepinephrine dose of 0.4 ± 0.5 mcg/kg/minute and their 28-day mortality was 31.5%. We openly acknowledged that slow recruitment was partly related to loss of equipoise; however, the above data not only appear representative of real life practice but are comparable to other contemporary septic shock studies, for example, VASST [
3]. His contention that 7 to 10 days of low-dose hydrocortisone should be considered in patients receiving norepinephrine or equivalent at doses >0.1 mcg/kg/minute within 12 hours of shock onset is not supported by any evidence base, contradicts presently accepted international recommendations [
4] and portrays a far more striking example of bias. …