Half Century of Corticosteroid Use in Septic Shock


  • Corticosteroid use in the treatment of sepsis has been ongoing for half a century.

  • Despite this long-term evaluation, there is still widespread disagreements regarding their risk-to-benefit ratio.

  • Current evidence does not support the use of corticosteroids either alone or in combination to improve sepsis mortality or organ dysfunction in septic shock.



  • The use of corticosteroids in sepsis is based on their immunosuppressive properties in the face of uncontrolled systemic inflammation with sepsis.

  • Corticosteroids also activate mineralocorticoid and glucocorticoid receptors which can help counter sepsis-induced hypovolemia by increasing sodium retention.

  • Corticosteroids can also improve alpha agonist responsiveness which can help increase systemic vascular resistance and elevate mean arterial pressure.


  • Corticosteroids can suppress the immune system., potentially allowing the underlying infection to worsen.
  • Their immunosuppressive properties can increase the risk of secondary infections, worsening the patient’s condition.
  • Corticosteroids can increase serum glucose values, mainly with bolus doses.
  • Corticosteroids can cause fluid retention and electrolyte imbalance, these may contribute to sepsis-induced organ dysfunction (i.e. acute kidney injury).


  • Recently, studies evaluating corticosteroids in sepsis have been used in combination with vitamin C and thiamine.

  • The potential benefit of combination therapy is to preserve endothelial function by including anti-inflammatory and antioxidant properties.

  • However, studies have not demonstrated a significant improvement in primary or secondary outcomes including:

    • Changes in SOFA score at 72 hours
    • Kidney failure
    • 30-day mortality
    • Ventilator free days
    • ICU-free days
  • A significant increase in shock-free days has been reported with the corticosteroid treatment group.


  • Based on data demonstrating limited value, the Surviving Sepsis Campaign recommendation of corticosteroid administration only applies to adults with septic shock requiring ongoing vasopressor support (greater than 4 hours).

  • After 50 years, we still do not have a definitive answer.

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Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (erkan@spo.icu), or video chat.