Acute effect of low-dose corticosteroids on muscle function in patients with severe sepsis and septic shock

Introduction

The rationale for the use of glucocorticoids in severe sepsis and septic shock can be attributed to well-defined anti-inflammatory and hemodynamic effects recognized for decades. However, with the introduction of corticosteroid therapy for a variety of conditions, it was reported that this treatment could induce a myopathy. Animal studies have confirmed that the administration of high doses of corticosteroid can produce myopathy affecting both ventilatory and peripheral skeletal muscles. Actually, it remains uncertain whether doses of corticosteroid, typically used to manage patients with severe sepsis and septic shock, do in fact cause peripheral and respiratory muscle weakness.

Objective

To study the effect of low-dose corticosteroids on the muscle force and submaximal exercise tolerance in septic patients.

Design

A prospective observational study of septic patients in a 14-bed medico-surgical ICU. Thirty-seven patients with severe sepsis and septic shock received low-dose corticosteroids or not.

Materials and methods

We collected data from septic patients from 2008. Muscle force and submaximal exercise tolerance were assessed at discharge from the hospital. Maximal inspiratory pressure (Pimax) was measured using pressure transducers; submaximal exercise tolerance was assessed by a 6-minute walk distance test; quadriceps and handgrip strength on the dominant side were evaluated using an isometric dynamometer.

Results

A total of 26 patients received low-dose corticosteroids, and 11 patients did not, during the study period. Age, SOFA, and time of hospital stay data were similar in the two groups. The APACHE and time of ICU stay values were significantly different between the group with corticosteroids versus the noncorticosteroid group (P < 0.05). The Pimax values were not different from those predicted for each group (60 ± 43% and 56 ± 34%, no corticosteroids vs corticosteroids), and the walking distance was not different. However, the peripheral muscle quadriceps presented 46 ± 21.8% versus 70 ± 40% (P < 0.05), respectively, with corticosteroids or not.

Conclusion

Low-dose corticosteroids did not alter Pimax and submaximal exercise tolerance on discharge from hospital. However, corticosteroids produced a significant reduction in peripheral muscle quadriceps. All patients presented a significant reduction of predicted force of quadriceps, showing corticosteroids can be responsible for the loss of peripheral muscular force.