What potential side effects should I be concerned about? Overall, the use of higher dose corticosteroids is associated with significant potential side effects, including a worsening of the underlying infection, new infection, hyperglycemia, hypernatremia, and gastrointestinal bleeding. In a meta-analysis of nine clinical trials with high-dose corticosteroids (a starting dose of ~30mg/kg/day of methylprednisolone), Cronin and colleagues found a trend toward increased mortality due to secondary infections (relative risk ; 95% confidence interval, to ). 24 A recent meta-analysis of 15 trials found low-dose corticosteroids reduced ICU mortality and increased the proportion of shock reversal by Day 7 and by Day 28 without increasing the rate of gastroduodenal bleeding, super-infection, or hyperglycemia. 25
Background: The most recent surviving sepsis campaign recommends the use of hydrocortisone in patients with refractory septic shock (. vasopressor dependent). However, the use of hydrocortisone in severe sepsis without shock still remains a very controversial topic. Recommendations for hydrocortisone are mostly based on 2 randomized clinical trials (. Annane et al  and CORTICUS ), but subsequent meta-analyses had more mixed results. Shock reversal was consistently improved irrespective of disease severity; however, mortality outcomes were not as consistent. Therefore, it has been hypothesized that early hydrocortisone administration could prevent shock by attenuating patient’s inflammatory response.