To the Editor: The systematic review by Dr Annane and colleagues1 summarized the results of 22 clinical trials investigating corticosteroid therapy in sepsis. The review suggested that prolonged low-dose corticosteroid therapy (≥5 days, ≤300 mg/d of hydrocortisone or equivalent) decreases mortality and recommended treating adult patients with vasopressor-dependent septic shock. However, we believe that these recommendations are weakened by possible publication bias and by the relationship between severity of illness and the treatment effect of corticosteroids.
Minneci PC, Deans KJ, Natanson C. Corticosteroid Therapy for Severe Sepsis and Septic Shock. JAMA. 2009;302(15):1643-1645. doi:10.1001/jama.2009.1480