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Evevident
Original paper
2008NEJMPulmonary/Critical Care

CORTICUS

Hydrocortisone therapy for patients with septic shock

RCTSeptic shock

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Overview

Hydrocortisone hastened shock reversal but did not improve survival in CORTICUS.

Clinical takeaway

CORTICUS is the septic-shock steroid caution trial, best interpreted with APROCCHSS and ADRENAL when deciding steroid use for persistent vasopressor-dependent shock.

Key result

28-day mortality was not significantly reduced with hydrocortisone.

Practice impact

Steroids are for selected refractory septic shock, not routine sepsis treatment.

Evidence

Study design

Randomized, double-blind, placebo-controlled trial.

Enrollment

499

Follow-up

28 days for primary outcome.

Geography

Multinational

Clinical question

Does hydrocortisone improve survival in septic shock, and does response depend on corticotropin testing?

Population

  • Adults with septic shock.

Intervention

Hydrocortisone.

Comparator

Placebo.

Primary outcome

28-day mortality among patients without a response to corticotropin.

Hydrocortisone did not significantly reduce 28-day mortality in septic shock.

Between-group comparison / p=not significant

Key results

  • 28-day mortality was not significantly reduced.
  • Shock reversal occurred faster with hydrocortisone.
  • Superinfection and hyperglycemia were more common concerns.

Harms

  • Hyperglycemia, hypernatremia, and superinfection are practical steroid harms.

Clinical Use

When to cite

  • When discussing why septic-shock steroid evidence is mixed and patient selection matters.

Practice impact

  • Helped move practice away from routine corticotropin testing to guide septic-shock steroids.

Applicability

  • Septic shock patients where steroid use is being considered for persistent vasopressor need.

Limitations

  • Underpowered after early stopping and enrolled less-severe shock than some other steroid trials.
  • Does not exclude hemodynamic benefit.

Common misinterpretations

  • Do not cite CORTICUS as proof steroids never help; shock reversal improved and later trials add nuance.

Related evidence

APROCCHSS - Contrasting ResultProCESS - Context

Citation

Sprung CL, Annane D, Keh D, et al. Hydrocortisone therapy for patients with septic shock. N Engl J Med. 2008;358(2):111-124. doi:10.1056/NEJMoa071366