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Early administration of hydrocortisone replacement after advent of septic shock is a major determinant of final outcome

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Critical Care201115 (Suppl 1) :P412

  • Published:


  • Public Health
  • Regression Analysis
  • Hydrocortisone
  • Septic Shock
  • Emergency Medicine


The CORTICUS trial doubts the value of hydrocortisone replacement for final outcome of septic shock [1]. We hypothesized that the time of starting hydrocortisone may impact on the final outcome.


Retrospective analysis was made of prospectively collected data for 41 patients with septic shock (ACCP/SCCM 1992 definition) in the past year in two ICUs. Hydrocortisone was infused as suggested [2]. The time lapsing from start of vasopressors until start of hydrocortisone was determined by the patients' charts.


Early start of hydrocortisone was determined by the quartiles of lapsing time as less than 24 hours. The impact of early start is shown in Figure 1. The mean APACHE II score for patients in early start was 22.09 and for patients in late start was 18.33 (P = NS). Cox regression analysis revealed that the only factor affecting final outcome was early start of hydrocortisone (HR: 4.85, 95% CI: 1.11 to 21.22, P = 0.036) as opposed to appropriateness of antimicrobial treatment (HR: 2.80, 95% CI: 0.56 to 13.91, P = NS).
Figure 1
Figure 1

Survival in relation to start of hydrocortisone.


Despite the observational approach, early start of hydrocortisone replacement in septic shock is a critical factor for outcome.

Authors’ Affiliations

Korgialeneio Benakeio Hospital, Athens, Greece
Medical School, University of Athens, Athens, Greece
Attikon University Hospital, Athens, Greece


  1. Sprung CL, et al.: N Engl J Med. 2008, 358: 111. 10.1056/NEJMoa071366View ArticlePubMedGoogle Scholar
  2. Marik PE, et al.: Crit Care Med. 2008, 36: 1937. 10.1097/CCM.0b013e31817603baView ArticlePubMedGoogle Scholar


© Katsenos et al. 2011

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.