Intensive Care Medicine

, Volume 38, Issue 12, pp 1946–1954 | Cite as

Low-dose steroids in adult septic shock: results of the Surviving Sepsis Campaign

  • Brian CasserlyEmail author
  • Herwig Gerlach
  • Gary S. Phillips
  • Stanley Lemeshow
  • John C. Marshall
  • Tiffany M. Osborn
  • Mitchell M. Levy



The Surviving Sepsis Campaign (SSC) developed guidelines and treatment bundles for the administration of steroids in adult septic shock. However, it is not clear how this has affected clinical practice or patient outcome.

Design and setting

The SSC has developed an extensive database to assess the overall effect of its guidelines on clinical practice and patient outcome. This analysis focuses on one particular element of the SSC’s management bundle, namely, the administration of low-dose steroids in adult septic shock. This analysis was conducted on data submitted from January 2005 through March 2010 including 27,836 subjects at 218 sites.

Main results

A total of 17,847 (of the total 27,836) patients in the database required vasopressor therapy despite fluid resuscitation and therefore met the eligibility criteria for receiving low-dose steroids. A total of 8,992 patients (50.4 %) received low-dose steroids for their septic shock. Patients in Europe (59.4 %) and South America (51.9 %) were more likely to be prescribed low-dose steroids compared to their counterparts in North America (46.2 %, p < 0.001). The adjusted hospital mortality was significantly higher (OR 1.18, 95 % CI 1.09–1.23, p < 0.001) in patients who received low-dose steroids compared to those who did not. There was still an association with increased adjusted hospital mortality with low-dose steroids even if they were prescribed within 8 h (OR 1.23, 95 % CI 1.13–1.34, p < 0.001).


Steroids were commonly administered in the treatment of septic shock in this subset analysis of the Surviving Sepsis Campaign database. However, this was associated with an increase in adjusted hospital mortality.


Surviving Sepsis Campaign Low-dose steroids Sepsis mortality 



The Surviving Sepsis Campaign was funded in part by unrestricted educational grants from Eli Lilly Co. and Edwards Lifesciences

Conflicts of interest

Brian Casserly, Herwig Gerlach, Gary Philips, John C. Marshall, Stanley Lemeshow and Mitchell M. Levy report no conflicts of interest with regard to this manuscript.

Supplementary material

134_2012_2720_MOESM1_ESM.doc (295 kb)
Supplementary Appendix A (DOC 295 kb)
134_2012_2720_MOESM2_ESM.doc (72 kb)
Supplementary Appendix B (DOC 73 kb)
134_2012_2720_MOESM3_ESM.doc (54 kb)
Supplementary Appendix C (DOC 54 kb)
134_2012_2720_MOESM4_ESM.doc (24 kb)
Supplementary Appendix D (DOC 24 kb)
134_2012_2720_MOESM5_ESM.doc (47 kb)
Supplementary Appendix E (DOC 47 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2012

Authors and Affiliations

  • Brian Casserly
    • 1
    • 2
    Email author
  • Herwig Gerlach
    • 3
  • Gary S. Phillips
    • 4
  • Stanley Lemeshow
    • 5
  • John C. Marshall
    • 6
  • Tiffany M. Osborn
    • 7
  • Mitchell M. Levy
    • 2
    • 8
  1. 1.University of Limerick, Graduate Entry Medical SchoolLimerickIreland
  2. 2.The Brown Alpert Medical SchoolProvidenceUSA
  3. 3.Division of Anesthesiology and Critical CareVivantes-Klinikum NeukoellnBerlinGermany
  4. 4.The Ohio State University Center for BiostatisticsColumbusUSA
  5. 5.The Ohio State University College of Public HealthColumbusUSA
  6. 6.Li Ka Shing Knowledge Institute, St. Michael’s HospitalUniversity of TorontoTorontoCanada
  7. 7.Department of Surgery and Division of Emergency Medicine, Surgical/Trauma Critical Care, Barnes Jewish HospitalWashington University School of MedicineSt. LouisUSA
  8. 8.Division of Critical CareRhode Island HospitalProvidenceUSA

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