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  • Letter
  • Open Access

Glucocorticoids in sepsis: dissecting facts from fiction

  • 1Email author,
  • 2,
  • 3,
  • 4,
  • 5 and
Critical Care201115:446

  • Published:


  • Hydrocortisone
  • Norepinephrine
  • Glucocorticoid
  • Septic Shock
  • Organ Dysfunction

Dr Marik's recent commentary [1] states that " 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.


Authors’ Affiliations

Hadassah Hebrew University Medical Center, Jerusalem, 91120, Israel
Raymond Poincaré Hospital (Assistance Publique-Hôpitaux de Paris), Garches, CP 92380, France
University College London, London, WC1E 6BT, UK
UCIP, Hospital de St António dis Capuchos, Centro Hospitalar de Lisboa Central, E.P.E, Lisbon, 1169-050, Portugal
Charité, Universitaetsmedizin, Berlin, 13353, Germany


  1. Marik PE: Glucocorticoids in sepsis: dissecting facts from fiction. Crit Care 2011, 15: 158. 10.1186/cc10101PubMed CentralView ArticlePubMedGoogle Scholar
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