Effects of hydrocortisone on posttraumatic stress disorder after septic shock: results from the CORTICUS Berlin Study Group

Introduction

Posttraumatic distress disorder (PTSD) and impaired heath-related quality of life (HRQoL) are important outcome parameters of ICU treatment. There is evidence that PTSD is associated with dysregulation of the hypothalamus pituitary adrenal axis [1]. Administration of hydrocortisone (HC) during ongoing trauma might be protective for PTSD [2]. PTSD and HRQoL were prospectively evaluated in septic shock patients enrolled in a substudy of the CORTICUS trial.

Methods

Eighty-four patients enrolled in the randomized controlled study of HC in septic shock who received HC (50 mg every 6 hours for 5 days, tapered until day 11) or placebo (PL) [3] were screened for eligibility. Mental disorders (SKID 1, BDI), PTSD (PTSS-10, KPS), and HRQoL (SF-36) were investigated 1 year after discharge from the ICU. Baseline SAPS II values were calculated. Adrenal function (cortisol before/after 250 μg adrenocorticotrophic hormone) was tested at the time of the interview.

Results

Eighteen out of 84 patients were interviewed (44 dead, 20 rejected participation, two dropouts). Nine of them had received HC and nine PL; six (30%) suffered from PTSD. Vitality and mental health (subscales of HRQoL) were significantly reduced in patients with PTSD (P < 0.05). There was no correlation between the severity of disease (SAPS II) and development of PTSD, and no difference in the physical dimension between patients with and without PTSD. The incidence of PTSD did not differ between patients in the HC and PL groups.

Conclusion

PTSD and the mental dimension of HRQoL is a relevant factor for long-term outcome after septic shock. Application of HC did not reduce development of PTSD. Adrenal function did not differentiate between patients with and without PTSD. The interpretation of the results is limited due to the small sample size, and further prospective studies are warranted.