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Stress doses of hydrocortisone in septic shock: beneficial effects on opsonization-dependent neutrophil functions

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Abstract

Objective

To assess the effects of stress doses of hydrocortisone (HC) on clinical parameters and neutrophil functions in patients with septic shock.

Design

Prospective, double-blind, randomized, placebo-controlled study.

Setting

Intensive care units of a university hospital.

Patients and participants

30 adult patients with septic shock.

Interventions

Patients were allocated to receive either HC (intravenous bolus of 100 mg preceding a continuous infusion 10 mg/h, n = 15) or placebo (n = 15), respectively. The effects of HC were assessed at baseline and after 24 h.

Measurements and results

As compared with placebo-treated patients, administration of HC significantly decreased norepinephrine requirements (from 1.5 to 0.8 mg/h; p < 0.001), interleukin-6 serum concentrations (from 388.8 to 88.8 pg/ml; p < 0.02), and the spontaneous release of hydrogen peroxide (H2O2) by neutrophils (−33.0%; p < 0.05). Additionally, HC treatment preserved the autologous plasma-induced amplification of phagocytosis of zymosan particles [factor of opsonin-induced amplification of phagocytosis of unopsonized particles: 1.80 for placebo vs. 1.75 for HC at baseline (not significant between groups) and 0.50 for placebo vs. 1.75 for HC after 24 h of treatment (p < 0.05)]. These effects were paralleled by respective changes in the phagocytosis-associated H2O2 production.

Conclusions

In patients with septic shock stress doses of HC exert beneficial effects in terms of improvements in hemodynamics, decrease in pro-inflammatory mediators, and oxidative stress without the compromise of opsonization-dependent phagocytic neutrophil functions; thus, HC treatment does not aggravate non-specific immunosuppression but instead improves innate immunity in the early stage of septic shock.

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Acknowledgements

The authors are grateful to M. Hoerl for her technical assistance with experiments.

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Authors and Affiliations

  1. Clinic of Anesthesiology, Ludwig Maximilians University, Klinikum Grosshadern, 81377, Munich, Germany

    Ines Kaufmann, Josef Briegel, Florian Schliephake, Alwin Hoelzl, Alexander Chouker, Gustav Schelling & Manfred Thiel

  2. Department of Surgery, Ludwig Maximilians University, Klinikum Innenstadt, 81377, Munich, Germany

    Theresia Hummel

Authors
  1. Ines Kaufmann
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  2. Josef Briegel
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  3. Florian Schliephake
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  4. Alwin Hoelzl
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  5. Alexander Chouker
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  6. Theresia Hummel
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  7. Gustav Schelling
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  8. Manfred Thiel
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Correspondence to Manfred Thiel.

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Kaufmann, I., Briegel, J., Schliephake, F. et al. Stress doses of hydrocortisone in septic shock: beneficial effects on opsonization-dependent neutrophil functions. Intensive Care Med 34, 344–349 (2008). https://doi.org/10.1007/s00134-007-0868-8

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  • DOI: https://doi.org/10.1007/s00134-007-0868-8

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