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October 21, 2009

Corticosteroid Therapy for Severe Sepsis and Septic Shock

JAMA. 2009;302(15):1643-1645. doi:10.1001/jama.2009.1480

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.