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January 1, 2003

Corticosteroids for Patients With Septic Shock

JAMA. 2003;289(1):41-44. doi:10.1001/jama.289.1.41-a

To the Editor: Dr Annane and colleagues1 found that corticosteroids reduced the risk of mortality in septic shock only among patients who did not respond to a corticotropin stimulation test. Some of these "nonresponders" had a baseline cortisol of less than 34 µg/dL with an increase of less than 9 µg/dL, and thus many of those may have had absolute adrenal deficiency. Such patients have a high risk of mortality2 and it may be inappropriate to randomize them to receive placebo. It would also be of interest to know how many of the nonresponders in this study had absolute adrenal deficiency and the effect of removing such patients from the analysis.

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