The benefits of steroids in treating sepsis were finally revealed. Recent meta-analysis showed that a low dose of steroids are actually beneficial to sepsis patients. This analysis was explained by Dr. Peter C. Minneci, MD, of the NIH in Bethesda, Maryland. The new meta-analysis confirmed that a delayed, low-dose five- to seven-day steroid regimen followed by steroid taper for an equal period is effective regardless of response to corticotropin stimulation test. The finding is contrary to the previous studies because according to Dr. Minneci, none of the earlier studies used steroid tapers, while newer studies use tapers and sicker patients.

From Medscape today:

The difficulty with steroid use is that most published articles provide little evidence to back up claims of efficacy. For example, Dr. Minneci said a literature search identified 1,324 articles, of which 162 were clinical trials, but most of those were not randomized.

“Studies published after 1997 consistently report a beneficial effect for steroids. Four studies report a mortality benefit.” “The newer studies generally enrolled sicker patients — for example, control mortality in the recent studies is 57% while in the earlier studies it was 34%, and 100% of patients in the recent studies are on vasopressors,” Dr. Minneci said.

The difference in total steroid dose is also striking: In the earlier studies, total steroid dose was 23,975 mg while in the newer studies total steroid dose is 1,209 mg. “And none of the earlier studies used steroid tapers, while all of newer studies used tapers, Dr. Minneci added.

Doctor Minneci found out that in the studies published before 1989, steroids were initiated in less than two hours, while in the later trials steroid therapy was started at 23 hours and administered for an average of six days rather than one day, which was the case in the earlier studies.

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