Evidence map›Paper›PMID 29347874›Full record

Trial reportThe New England journal of medicine2018

Adjunctive Glucocorticoid Therapy in Patients with Septic Shock.

Balasubramanian Venkatesh, Simon Finfer, Jeremy Cohen, Dorrilyn Rajbhandari, Yaseen Arabi, Rinaldo Bellomo, Laurent Billot, Maryam Correa, Parisa Glass, Meg Harward and 9 more

3 registry-linked trialsOpen access · bronzeAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in The New England journal of medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 470 papers, 15 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
470citing papers in PubMed, 15 pooled it
82.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01448109 phase4completednot on this map

A Randomised Blinded Placebo Controlled Trial of Hydrocortisone in Critically Ill Patients With Septic Shock

TypeinterventionalSponsorThe George InstituteRan2012 to 2017Enrolled3,800ConditionsSeptic ShockArmsHydrocortisone, Sterile air filled vial
NCT04567433 completednot on this mapstarted 2020, after this paper: background citation

Days Alive and Out of Hospital for Patients With Sepsis

TypeobservationalSponsorThe George Institute for Global Health, AustraliaRan2020 to 2024Enrolled6,213ConditionsSepsis, Septic ShockArmsHydroxyethyl starch, Hydrocortisone, Early Goal Directed Therapy
NCT06473844 narecruitingnot on this mapstarted 2025, after this paper: background citation

Efficacy and Safety of Sodium-Glucose Cotransporter 2 Inhibitors in Adults With Sepsis: A Feasibility Study for a Multicenter Double-Blind Randomized Placebo-Controlled Trial

TypeinterventionalSponsorHospital Authority, Hong KongRan2025 to 2027Enrolled60ConditionsSepsis, Inflammation, SGLT2 Inhibitors, Critically IllArmsEmpagliflozin 10 MG, Placebo
3 · Its place in the literature

Who cites it

470 citing papers in PubMed, 15 syntheses or guidelines pooled it, 976 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Continuous versus Intermittent Hydrocortisone for the Treatment of Septic Shock: A Systematic Review and Meta-Analysis.Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2026
    Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Corticosteroids for treating sepsis in children and adults.The Cochrane database of systematic reviews · 2025
    Pooled it
  9. Pooled it
  10. Pooled it
  11. Pooled it
  12. Pooled it
  13. Pooled it
  14. Pooled it
  15. Pooled it
  16. Trial
  17. Trial
  18. Low-Dose Hydrocortisone in Cirrhotic Patients With Septic Shock: A Double-Blind Randomised Placebo-Controlled Trial.Liver international : official journal of the International Association for the Study of the Liver · 2025
    Trial
  19. Trial
  20. Trial

410 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

19 authors at 8 institutions in 7 countries.

Balasubramanian VenkateshFrom the George Institute for Global Health, University of New South Wales (B.V., S.F., D.R., L.B., M.C., P.G., M.H., Q.L., K.T., J.M.), St. George Clinical School, St. George Hospital (J.M.), Sydney Medical School, University of Sydney (B.V., S.F., J.M.), and Royal North Shore Hospital (S.F.), Sydney, the Princess Alexandra Hospital (B.V., C.J.) and Royal Brisbane and Women's Hospital (J.C.), University of Queensland, and the Wesley Hospital (B.V., J.C.), Brisbane, Austin Hospital (R.B.), the School of Medicine, University of Melbourne (R.B.), and the Australian and New Zealand Research Centre (R.B.), School of Public Health and Preventive Medicine (R.B., S.W., J.M.), Monash University, Melbourne, VIC, and Royal Perth Hospital (S.W.) and the School of Medicine and Pharmacology, University of Western Australia (S.W.), Perth - all in Australia; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Y.A.); the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.); Rigshospitalet, University of Copenhagen, Copenhagen (A.P.); and St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London (A.R.).
Simon FinferFrom the George Institute for Global Health, University of New South Wales (B.V., S.F., D.R., L.B., M.C., P.G., M.H., Q.L., K.T., J.M.), St. George Clinical School, St. George Hospital (J.M.), Sydney Medical School, University of Sydney (B.V., S.F., J.M.), and Royal North Shore Hospital (S.F.), Sydney, the Princess Alexandra Hospital (B.V., C.J.) and Royal Brisbane and Women's Hospital (J.C.), University of Queensland, and the Wesley Hospital (B.V., J.C.), Brisbane, Austin Hospital (R.B.), the School of Medicine, University of Melbourne (R.B.), and the Australian and New Zealand Research Centre (R.B.), School of Public Health and Preventive Medicine (R.B., S.W., J.M.), Monash University, Melbourne, VIC, and Royal Perth Hospital (S.W.) and the School of Medicine and Pharmacology, University of Western Australia (S.W.), Perth - all in Australia; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Y.A.); the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.); Rigshospitalet, University of Copenhagen, Copenhagen (A.P.); and St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London (A.R.).
Jeremy CohenFrom the George Institute for Global Health, University of New South Wales (B.V., S.F., D.R., L.B., M.C., P.G., M.H., Q.L., K.T., J.M.), St. George Clinical School, St. George Hospital (J.M.), Sydney Medical School, University of Sydney (B.V., S.F., J.M.), and Royal North Shore Hospital (S.F.), Sydney, the Princess Alexandra Hospital (B.V., C.J.) and Royal Brisbane and Women's Hospital (J.C.), University of Queensland, and the Wesley Hospital (B.V., J.C.), Brisbane, Austin Hospital (R.B.), the School of Medicine, University of Melbourne (R.B.), and the Australian and New Zealand Research Centre (R.B.), School of Public Health and Preventive Medicine (R.B., S.W., J.M.), Monash University, Melbourne, VIC, and Royal Perth Hospital (S.W.) and the School of Medicine and Pharmacology, University of Western Australia (S.W.), Perth - all in Australia; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Y.A.); the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.); Rigshospitalet, University of Copenhagen, Copenhagen (A.P.); and St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London (A.R.).
Dorrilyn RajbhandariFrom the George Institute for Global Health, University of New South Wales (B.V., S.F., D.R., L.B., M.C., P.G., M.H., Q.L., K.T., J.M.), St. George Clinical School, St. George Hospital (J.M.), Sydney Medical School, University of Sydney (B.V., S.F., J.M.), and Royal North Shore Hospital (S.F.), Sydney, the Princess Alexandra Hospital (B.V., C.J.) and Royal Brisbane and Women's Hospital (J.C.), University of Queensland, and the Wesley Hospital (B.V., J.C.), Brisbane, Austin Hospital (R.B.), the School of Medicine, University of Melbourne (R.B.), and the Australian and New Zealand Research Centre (R.B.), School of Public Health and Preventive Medicine (R.B., S.W., J.M.), Monash University, Melbourne, VIC, and Royal Perth Hospital (S.W.) and the School of Medicine and Pharmacology, University of Western Australia (S.W.), Perth - all in Australia; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Y.A.); the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.); Rigshospitalet, University of Copenhagen, Copenhagen (A.P.); and St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London (A.R.).
Yaseen ArabiFrom the George Institute for Global Health, University of New South Wales (B.V., S.F., D.R., L.B., M.C., P.G., M.H., Q.L., K.T., J.M.), St. George Clinical School, St. George Hospital (J.M.), Sydney Medical School, University of Sydney (B.V., S.F., J.M.), and Royal North Shore Hospital (S.F.), Sydney, the Princess Alexandra Hospital (B.V., C.J.) and Royal Brisbane and Women's Hospital (J.C.), University of Queensland, and the Wesley Hospital (B.V., J.C.), Brisbane, Austin Hospital (R.B.), the School of Medicine, University of Melbourne (R.B.), and the Australian and New Zealand Research Centre (R.B.), School of Public Health and Preventive Medicine (R.B., S.W., J.M.), Monash University, Melbourne, VIC, and Royal Perth Hospital (S.W.) and the School of Medicine and Pharmacology, University of Western Australia (S.W.), Perth - all in Australia; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Y.A.); the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.); Rigshospitalet, University of Copenhagen, Copenhagen (A.P.); and St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London (A.R.).
Rinaldo BellomoFrom the George Institute for Global Health, University of New South Wales (B.V., S.F., D.R., L.B., M.C., P.G., M.H., Q.L., K.T., J.M.), St. George Clinical School, St. George Hospital (J.M.), Sydney Medical School, University of Sydney (B.V., S.F., J.M.), and Royal North Shore Hospital (S.F.), Sydney, the Princess Alexandra Hospital (B.V., C.J.) and Royal Brisbane and Women's Hospital (J.C.), University of Queensland, and the Wesley Hospital (B.V., J.C.), Brisbane, Austin Hospital (R.B.), the School of Medicine, University of Melbourne (R.B.), and the Australian and New Zealand Research Centre (R.B.), School of Public Health and Preventive Medicine (R.B., S.W., J.M.), Monash University, Melbourne, VIC, and Royal Perth Hospital (S.W.) and the School of Medicine and Pharmacology, University of Western Australia (S.W.), Perth - all in Australia; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Y.A.); the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.); Rigshospitalet, University of Copenhagen, Copenhagen (A.P.); and St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London (A.R.).
Laurent BillotFrom the George Institute for Global Health, University of New South Wales (B.V., S.F., D.R., L.B., M.C., P.G., M.H., Q.L., K.T., J.M.), St. George Clinical School, St. George Hospital (J.M.), Sydney Medical School, University of Sydney (B.V., S.F., J.M.), and Royal North Shore Hospital (S.F.), Sydney, the Princess Alexandra Hospital (B.V., C.J.) and Royal Brisbane and Women's Hospital (J.C.), University of Queensland, and the Wesley Hospital (B.V., J.C.), Brisbane, Austin Hospital (R.B.), the School of Medicine, University of Melbourne (R.B.), and the Australian and New Zealand Research Centre (R.B.), School of Public Health and Preventive Medicine (R.B., S.W., J.M.), Monash University, Melbourne, VIC, and Royal Perth Hospital (S.W.) and the School of Medicine and Pharmacology, University of Western Australia (S.W.), Perth - all in Australia; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Y.A.); the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.); Rigshospitalet, University of Copenhagen, Copenhagen (A.P.); and St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London (A.R.).ORCID 0000-0002-4975-9793
Maryam CorreaFrom the George Institute for Global Health, University of New South Wales (B.V., S.F., D.R., L.B., M.C., P.G., M.H., Q.L., K.T., J.M.), St. George Clinical School, St. George Hospital (J.M.), Sydney Medical School, University of Sydney (B.V., S.F., J.M.), and Royal North Shore Hospital (S.F.), Sydney, the Princess Alexandra Hospital (B.V., C.J.) and Royal Brisbane and Women's Hospital (J.C.), University of Queensland, and the Wesley Hospital (B.V., J.C.), Brisbane, Austin Hospital (R.B.), the School of Medicine, University of Melbourne (R.B.), and the Australian and New Zealand Research Centre (R.B.), School of Public Health and Preventive Medicine (R.B., S.W., J.M.), Monash University, Melbourne, VIC, and Royal Perth Hospital (S.W.) and the School of Medicine and Pharmacology, University of Western Australia (S.W.), Perth - all in Australia; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Y.A.); the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.); Rigshospitalet, University of Copenhagen, Copenhagen (A.P.); and St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London (A.R.).
Parisa GlassFrom the George Institute for Global Health, University of New South Wales (B.V., S.F., D.R., L.B., M.C., P.G., M.H., Q.L., K.T., J.M.), St. George Clinical School, St. George Hospital (J.M.), Sydney Medical School, University of Sydney (B.V., S.F., J.M.), and Royal North Shore Hospital (S.F.), Sydney, the Princess Alexandra Hospital (B.V., C.J.) and Royal Brisbane and Women's Hospital (J.C.), University of Queensland, and the Wesley Hospital (B.V., J.C.), Brisbane, Austin Hospital (R.B.), the School of Medicine, University of Melbourne (R.B.), and the Australian and New Zealand Research Centre (R.B.), School of Public Health and Preventive Medicine (R.B., S.W., J.M.), Monash University, Melbourne, VIC, and Royal Perth Hospital (S.W.) and the School of Medicine and Pharmacology, University of Western Australia (S.W.), Perth - all in Australia; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Y.A.); the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.); Rigshospitalet, University of Copenhagen, Copenhagen (A.P.); and St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London (A.R.).
Meg HarwardFrom the George Institute for Global Health, University of New South Wales (B.V., S.F., D.R., L.B., M.C., P.G., M.H., Q.L., K.T., J.M.), St. George Clinical School, St. George Hospital (J.M.), Sydney Medical School, University of Sydney (B.V., S.F., J.M.), and Royal North Shore Hospital (S.F.), Sydney, the Princess Alexandra Hospital (B.V., C.J.) and Royal Brisbane and Women's Hospital (J.C.), University of Queensland, and the Wesley Hospital (B.V., J.C.), Brisbane, Austin Hospital (R.B.), the School of Medicine, University of Melbourne (R.B.), and the Australian and New Zealand Research Centre (R.B.), School of Public Health and Preventive Medicine (R.B., S.W., J.M.), Monash University, Melbourne, VIC, and Royal Perth Hospital (S.W.) and the School of Medicine and Pharmacology, University of Western Australia (S.W.), Perth - all in Australia; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Y.A.); the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.); Rigshospitalet, University of Copenhagen, Copenhagen (A.P.); and St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London (A.R.).
Christopher JoyceFrom the George Institute for Global Health, University of New South Wales (B.V., S.F., D.R., L.B., M.C., P.G., M.H., Q.L., K.T., J.M.), St. George Clinical School, St. George Hospital (J.M.), Sydney Medical School, University of Sydney (B.V., S.F., J.M.), and Royal North Shore Hospital (S.F.), Sydney, the Princess Alexandra Hospital (B.V., C.J.) and Royal Brisbane and Women's Hospital (J.C.), University of Queensland, and the Wesley Hospital (B.V., J.C.), Brisbane, Austin Hospital (R.B.), the School of Medicine, University of Melbourne (R.B.), and the Australian and New Zealand Research Centre (R.B.), School of Public Health and Preventive Medicine (R.B., S.W., J.M.), Monash University, Melbourne, VIC, and Royal Perth Hospital (S.W.) and the School of Medicine and Pharmacology, University of Western Australia (S.W.), Perth - all in Australia; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Y.A.); the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.); Rigshospitalet, University of Copenhagen, Copenhagen (A.P.); and St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London (A.R.).
Qiang LiFrom the George Institute for Global Health, University of New South Wales (B.V., S.F., D.R., L.B., M.C., P.G., M.H., Q.L., K.T., J.M.), St. George Clinical School, St. George Hospital (J.M.), Sydney Medical School, University of Sydney (B.V., S.F., J.M.), and Royal North Shore Hospital (S.F.), Sydney, the Princess Alexandra Hospital (B.V., C.J.) and Royal Brisbane and Women's Hospital (J.C.), University of Queensland, and the Wesley Hospital (B.V., J.C.), Brisbane, Austin Hospital (R.B.), the School of Medicine, University of Melbourne (R.B.), and the Australian and New Zealand Research Centre (R.B.), School of Public Health and Preventive Medicine (R.B., S.W., J.M.), Monash University, Melbourne, VIC, and Royal Perth Hospital (S.W.) and the School of Medicine and Pharmacology, University of Western Australia (S.W.), Perth - all in Australia; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Y.A.); the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.); Rigshospitalet, University of Copenhagen, Copenhagen (A.P.); and St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London (A.R.).
Colin McArthurFrom the George Institute for Global Health, University of New South Wales (B.V., S.F., D.R., L.B., M.C., P.G., M.H., Q.L., K.T., J.M.), St. George Clinical School, St. George Hospital (J.M.), Sydney Medical School, University of Sydney (B.V., S.F., J.M.), and Royal North Shore Hospital (S.F.), Sydney, the Princess Alexandra Hospital (B.V., C.J.) and Royal Brisbane and Women's Hospital (J.C.), University of Queensland, and the Wesley Hospital (B.V., J.C.), Brisbane, Austin Hospital (R.B.), the School of Medicine, University of Melbourne (R.B.), and the Australian and New Zealand Research Centre (R.B.), School of Public Health and Preventive Medicine (R.B., S.W., J.M.), Monash University, Melbourne, VIC, and Royal Perth Hospital (S.W.) and the School of Medicine and Pharmacology, University of Western Australia (S.W.), Perth - all in Australia; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Y.A.); the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.); Rigshospitalet, University of Copenhagen, Copenhagen (A.P.); and St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London (A.R.).
Anders PernerFrom the George Institute for Global Health, University of New South Wales (B.V., S.F., D.R., L.B., M.C., P.G., M.H., Q.L., K.T., J.M.), St. George Clinical School, St. George Hospital (J.M.), Sydney Medical School, University of Sydney (B.V., S.F., J.M.), and Royal North Shore Hospital (S.F.), Sydney, the Princess Alexandra Hospital (B.V., C.J.) and Royal Brisbane and Women's Hospital (J.C.), University of Queensland, and the Wesley Hospital (B.V., J.C.), Brisbane, Austin Hospital (R.B.), the School of Medicine, University of Melbourne (R.B.), and the Australian and New Zealand Research Centre (R.B.), School of Public Health and Preventive Medicine (R.B., S.W., J.M.), Monash University, Melbourne, VIC, and Royal Perth Hospital (S.W.) and the School of Medicine and Pharmacology, University of Western Australia (S.W.), Perth - all in Australia; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Y.A.); the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.); Rigshospitalet, University of Copenhagen, Copenhagen (A.P.); and St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London (A.R.).
Andrew RhodesFrom the George Institute for Global Health, University of New South Wales (B.V., S.F., D.R., L.B., M.C., P.G., M.H., Q.L., K.T., J.M.), St. George Clinical School, St. George Hospital (J.M.), Sydney Medical School, University of Sydney (B.V., S.F., J.M.), and Royal North Shore Hospital (S.F.), Sydney, the Princess Alexandra Hospital (B.V., C.J.) and Royal Brisbane and Women's Hospital (J.C.), University of Queensland, and the Wesley Hospital (B.V., J.C.), Brisbane, Austin Hospital (R.B.), the School of Medicine, University of Melbourne (R.B.), and the Australian and New Zealand Research Centre (R.B.), School of Public Health and Preventive Medicine (R.B., S.W., J.M.), Monash University, Melbourne, VIC, and Royal Perth Hospital (S.W.) and the School of Medicine and Pharmacology, University of Western Australia (S.W.), Perth - all in Australia; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Y.A.); the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.); Rigshospitalet, University of Copenhagen, Copenhagen (A.P.); and St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London (A.R.).
Kelly ThompsonFrom the George Institute for Global Health, University of New South Wales (B.V., S.F., D.R., L.B., M.C., P.G., M.H., Q.L., K.T., J.M.), St. George Clinical School, St. George Hospital (J.M.), Sydney Medical School, University of Sydney (B.V., S.F., J.M.), and Royal North Shore Hospital (S.F.), Sydney, the Princess Alexandra Hospital (B.V., C.J.) and Royal Brisbane and Women's Hospital (J.C.), University of Queensland, and the Wesley Hospital (B.V., J.C.), Brisbane, Austin Hospital (R.B.), the School of Medicine, University of Melbourne (R.B.), and the Australian and New Zealand Research Centre (R.B.), School of Public Health and Preventive Medicine (R.B., S.W., J.M.), Monash University, Melbourne, VIC, and Royal Perth Hospital (S.W.) and the School of Medicine and Pharmacology, University of Western Australia (S.W.), Perth - all in Australia; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Y.A.); the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.); Rigshospitalet, University of Copenhagen, Copenhagen (A.P.); and St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London (A.R.).
Steve WebbFrom the George Institute for Global Health, University of New South Wales (B.V., S.F., D.R., L.B., M.C., P.G., M.H., Q.L., K.T., J.M.), St. George Clinical School, St. George Hospital (J.M.), Sydney Medical School, University of Sydney (B.V., S.F., J.M.), and Royal North Shore Hospital (S.F.), Sydney, the Princess Alexandra Hospital (B.V., C.J.) and Royal Brisbane and Women's Hospital (J.C.), University of Queensland, and the Wesley Hospital (B.V., J.C.), Brisbane, Austin Hospital (R.B.), the School of Medicine, University of Melbourne (R.B.), and the Australian and New Zealand Research Centre (R.B.), School of Public Health and Preventive Medicine (R.B., S.W., J.M.), Monash University, Melbourne, VIC, and Royal Perth Hospital (S.W.) and the School of Medicine and Pharmacology, University of Western Australia (S.W.), Perth - all in Australia; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Y.A.); the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.); Rigshospitalet, University of Copenhagen, Copenhagen (A.P.); and St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London (A.R.).
John MyburghFrom the George Institute for Global Health, University of New South Wales (B.V., S.F., D.R., L.B., M.C., P.G., M.H., Q.L., K.T., J.M.), St. George Clinical School, St. George Hospital (J.M.), Sydney Medical School, University of Sydney (B.V., S.F., J.M.), and Royal North Shore Hospital (S.F.), Sydney, the Princess Alexandra Hospital (B.V., C.J.) and Royal Brisbane and Women's Hospital (J.C.), University of Queensland, and the Wesley Hospital (B.V., J.C.), Brisbane, Austin Hospital (R.B.), the School of Medicine, University of Melbourne (R.B.), and the Australian and New Zealand Research Centre (R.B.), School of Public Health and Preventive Medicine (R.B., S.W., J.M.), Monash University, Melbourne, VIC, and Royal Perth Hospital (S.W.) and the School of Medicine and Pharmacology, University of Western Australia (S.W.), Perth - all in Australia; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Y.A.); the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.); Rigshospitalet, University of Copenhagen, Copenhagen (A.P.); and St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London (A.R.).
ADRENAL Trial Investigators and the Australian–New Zealand Intensive Care Society Clinical Trials Group
The University of Queensland · AUThe University of Sydney · AUAuckland City Hospital · NZKing Saud bin Abdulaziz University for Health Sciences · SASt George's, University of London · GBThe University of Melbourne · AUThe University of Western Australia · AUUniversity of Copenhagen · DK

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWhether hydrocortisone reduces mortality among patients with septic shock is unclear.

methodsWe randomly assigned patients with septic shock who were undergoing mechanical ventilation to receive hydrocortisone (at a dose of 200 mg per day) or placebo for 7 days or until death or discharge from the intensive care unit (ICU), whichever came first. The primary outcome was death from any cause at 90 days.

resultsFrom March 2013 through April 2017, a total of 3800 patients underwent randomization. Status with respect to the primary outcome was ascertained in 3658 patients (1832 of whom had been assigned to the hydrocortisone group and 1826 to the placebo group). At 90 days, 511 patients (27.9%) in the hydrocortisone group and 526 (28.8%) in the placebo group had died (odds ratio, 0.95; 95% confidence interval [CI], 0.82 to 1.10; P=0.50). The effect of the trial regimen was similar in six prespecified subgroups. Patients who had been assigned to receive hydrocortisone had faster resolution of shock than those assigned to the placebo group (median duration, 3 days [interquartile range, 2 to 5] vs. 4 days [interquartile range, 2 to 9]; hazard ratio, 1.32; 95% CI, 1.23 to 1.41; P<0.001). Patients in the hydrocortisone group had a shorter duration of the initial episode of mechanical ventilation than those in the placebo group (median, 6 days [interquartile range, 3 to 18] vs. 7 days [interquartile range, 3 to 24]; hazard ratio, 1.13; 95% CI, 1.05 to 1.22; P<0.001), but taking into account episodes of recurrence of ventilation, there were no significant differences in the number of days alive and free from mechanical ventilation. Fewer patients in the hydrocortisone group than in the placebo group received a blood transfusion (37.0% vs. 41.7%; odds ratio, 0.82; 95% CI, 0.72 to 0.94; P=0.004). There were no significant between-group differences with respect to mortality at 28 days, the rate of recurrence of shock, the number of days alive and out of the ICU, the number of days alive and out of the hospital, the recurrence of mechanical ventilation, the rate of renal-replacement therapy, and the incidence of new-onset bacteremia or fungemia.

conclusionsAmong patients with septic shock undergoing mechanical ventilation, a continuous infusion of hydrocortisone did not result in lower 90-day mortality than placebo. (Funded by the National Health and Medical Research Council of Australia and others; ADRENAL ClinicalTrials.gov number, NCT01448109 .).

Indexed as

AgedAnti-Inflammatory AgentsAPACHEBacteremiaChemotherapy, AdjuvantDouble-Blind MethodFemaleFungemiaHumansHydrocortisoneInfusions, IntravenousMaleMiddle AgedRecurrenceRenal Replacement TherapyRespiration, ArtificialAnti-Inflammatory AgentsHydrocortisone

Identifiers

PMID29347874
OpenAlexW2784412824

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.