Low-dose hydrocortisone during severe sepsis: Effects on microalbuminuria

Objective: The aim of this study was to investigate the effect of low-dose hydrocortisone on glomerular permeability measured by the microalbuminuria to creatinine ratio (MACR) and on other markers of sepsis in severe septic patients. Design: Randomized prospective study. Setting., University intensive care unit. Patients: The study involved 40 patents with severe sepsis randomized into the hydrocortisone group (n = 20) and the standard therapy group (n = 20). Interventions., The hydrocortisone group received standard therapy plus a continuous infusion of hydrocortisone for 6 days, whereas the standard therapy group received only standard therapy. Measurements and Main Results: MACR, serum C-reactive protein, and procalcitonin concentrations were recorded every day from the day before the steroid therapy (T-0) until the 6 days after (T-1, T-2, T-3, T-4, T-5, and T-6) Concentrations in the hydrocortisone group and the standard therapy group were compared using Mann-Whitney test at each time. We also compared with Wilcoxon signed rank test the values determined in each group at T-0 with those at each subsequent time. Median MACR decreased from T-0 to T-6 in both patent groups; however, values were significantly lower in the hydrocortisone group from T-3 through to T-6. Median serum C-reactive protein also decreased from T-0 in both patient groups, with significantly lower values in the hydrocortisone group from T-3 through to T-6. There were no significant differences in procalcitonin between groups compared with baseline values or at any individual time point. Conclusions: Low-dose hydrocortisone seems to reduce MACR and serum C-reactive protein but not procalcitonin in patients with severe sepsis. Further studies are needed to confirm these results and to understand the underlying molecular mechanisms.