Sepsis is a severe bacterial infection that involves the entire body. According to MayoClinic.com, the mortality rate for this disease is almost 50 percent. The most important treatment for sepsis is antibiotics, to eradicate the infection, and a variety of other medications and intravenous fluids to correct many of the abnormalities that occur as a part of the disease. The role of steroids in the management of sepsis is controversial. Although they do not improve mortality, they may be useful in hastening recovery.
Sepsis
Sepsis is a severe condition in which bacteria grow and multiply in the blood. Sepsis can occur when a variety of infections gradually get out of control and spread to the entire body. Infections may begin in organs such as the lungs, urinary tract or brain. Unless rapidly treated, sepsis quickly leads to death. Symptoms of sepsis include altered or loss of consciousness, high fevers, a weak and rapid pulse, and a high rate of breathing. Individuals with severe sepsis may have areas of skin mottling, heart rhythm disturbances and arrested breathing.
Hydrocortisone
Many of the symptoms of sepsis are not due to the bacteria but rather to the body's own, overwhelming reaction. Hydrocortisone is a corticosteroid that is produced by the adrenal glands of the body. Hydrocortisone and a number of its synthetic derivatives of the hormone are used medically for a variety of conditions. Hydrocortisone is thought to help in sepsis by decreasing some of this inflammatory response. A historical study by Dr. William Schumer, published in the "Annals of Surgery" in 1976, found that patients in sepsis who were given steroid therapy had dramatically improved survival rates compared to patients who were not given the regimen. A number of studies have been done since then; however, none of these were definitive.
Hydrocortisone Therapy for Septic Shock
Despite the fact that steroids may or may not be beneficial to patients in shock, doctors still commonly prescribe them, though often late in the disease course. The most definitive study of steroid usage during septic shock was published in "The New England Journal of Medicine" in 2008. This study was carried out as a prospective study. The results of the study were conclusive: "Hydrocortisone," researchers wrote, "did not improve survival or reversal of shock in patients with septic shock." They did note, however, that in patients who did recover, hydrocortisone hastened the rate of recovery.
Waterhouse Friderichsen Syndrome
Waterhouse Friderichsen Syndrome is a specific type of sepsis caused by the bacteria, Neisseria Meningitidis. This bacteria often causes meningitis, a severe infection of the tissues that encase the brain, and may subsequently cause sepsis. The bacteria has a predilection for the adrenal glands. The damage to these organs may lead to an acute deficiency of steroids, which are vital to maintain life. A study published in 2007 by the "Cochrane Collaboration" found that there was a benefit with corticosteroids, which reduced mortality and prevented complications, such as hearing loss, in these patients.
References
- MayoClinic.com: Sepsis
- "New England Journal of Medicine"; Hydrocortisone Therapy for Patients With Septic Shock; Charles L. Sprung, et al.; 2008
- "Annals of Surgery"; Steroids in the Treatment of Clinical Septic Shock; William Schumer; 1976
- "Cochraine Databse of Systemic Reviews"; Corticosteroids for Acute Bacterial Meningitis; D. van de Beek, et al.; January 2007
