Treating adults with septic shock with intensive insulin therapy to counter elevated blood glucose levels associated with corticosteroid therapy did not result in a reduced risk of in-hospital death, compared to patients who received conventional insulin therapy, according to a study in the January 27 issue of JAMA. The researchers also found that adding a 2nd corticosteroid to treatment did not significantly reduce the risk of death within the hospital.
Septic shock is a major complication of infectious diseases, with a mortality rate of 60 percent within a short period, according to background information in the article. Corticosteroids are used in the treatment of septic shock and may provide a survival benefit, but their use is associated with hyperglycemia.
Djillali Annane, M.D., of the Hôpital Raymond Poincaré, Garches, France, and colleagues with the Corticosteroids and Intensive Insulin Therapy for Septic Shock (COIITSS) trial examined whether normalization of blood glucose levels with intensive insulin treatment would improve outcomes for adults with septic shock treated with hydrocortisone. Also, the researchers analyzed the benefit of adding the corticosteroid fludrocortisone to hydrocortisone therapy. The randomized trial, which included 509 adults with septic shock who had received hydrocortisone treatment, was conducted from Jan. 2006 to Jan. 2009 in 11 intensive care units in France.
Patients were randomly assigned to 1 of 4 groups: continuous intravenous insulin infusion with hydrocortisone alone; continuous intravenous insulin infusion with hydrocortisone plus fludrocortisone; conventional insulin therapy with hydrocortisone alone; or conventional insulin therapy with intravenous hydrocortisone plus fludrocortisone. Hydrocortisone was administered every 6 hours, and fludrocortisone was administered once a day for 7 days.