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 mark- ers of sepsis in severe septic patients. Design: Randomized prospective study. Setting: University intensive care unit. Patients: The study involved 40 patients with severe sepsis randomized into the hydrocortisone group (n 20) and the standard therapy group (n 20). Interventions: The hydrocortisone group received standard ther- apy 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 pro- tein, and procalcitonin concentrations were recorded every day from the day before the steroid therapy (T0) until the 6 days after (T1, T2, T3, T4, T5, and T6). 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 T0 with those at each subsequent time. Median MACR decreased from T0 to T6 in both patient groups; however, values were significantly lower in the hydrocortisone group from T3 through to T6. Median serum C-reactive protein also de- creased from T0 in both patient groups, with significantly lower values in the hydrocortisone group from T3 through to T6. 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.