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Letters
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: I am concerned that Dr Annane and colleagues1 studied a highly selected subgroup of the entire population of septic patients. Of the more than half million patients estimated to have severe sepsis in the United States annually,2 only a small fraction would have vasopressor- and ventilator-dependent septic shock with documented relative adrenal insufficiency within 1 to 8 hours of the onset of septic shock. Remarkably, only 24% of the patients in this study were bacteremic, yet they experienced an exceedingly high mortality rate of 55% to 61%. The majority of patients had a community-acquired infection with a nonfatal underlying disease state. Such patients should receive optimal supportive care and should have reversible disease physiology. It remains unclear whether corticosteroids benefit a more heterogeneous population with serious underlying diseases or nosocomial infections.

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