In Reply: Dr Brown asks whether the observed
reduction in mortality was related to the inclusion of a large number of patients
with absolute adrenal insufficiency. Among nonresponders, the percentage of
patients with absolute adrenal insufficiency (ie, cortisol levels before and
after corticotropin stimulation <18 µg/dL)1 was
45%. Removing such patients from the analysis of nonresponders increases the
difference between placebo and corticosteroid groups from 10% to 17%.
Annane D, Sebille V, Bellissant E. Corticosteroids for Patients With Septic Shock. JAMA. 2003;289(1):41-44. doi:10.1001/jama.289.1.41-a