Stress doses of hydrocortisone in septic shock: beneficial effects on opsonization-dependent neutrophil functions

Intensive Care Med. 2008 Feb;34(2):344-9. doi: 10.1007/s00134-007-0868-8. Epub 2007 Sep 29.


Objective: To assess the effects of stress doses of hydrocortisone (HC) on clinical parameters and neutrophil functions in patients with septic shock.

Design: Prospective, double-blind, randomized, placebo-controlled study.

Setting: Intensive care units of a university hospital.

Patients and participants: 30 adult patients with septic shock.

Interventions: Patients were allocated to receive either HC (intravenous bolus of 100 mg preceding a continuous infusion 10 mg/h, n = 15) or placebo (n = 15), respectively. The effects of HC were assessed at baseline and after 24 h.

Measurements and results: As compared with placebo-treated patients, administration of HC significantly decreased norepinephrine requirements (from 1.5 to 0.8 mg/h; p < 0.001), interleukin-6 serum concentrations (from 388.8 to 88.8 pg/ml; p < 0.02), and the spontaneous release of hydrogen peroxide (H2O2) by neutrophils (-33.0%; p < 0.05). Additionally, HC treatment preserved the autologous plasma-induced amplification of phagocytosis of zymosan particles [factor of opsonin-induced amplification of phagocytosis of unopsonized particles: 1.80 for placebo vs. 1.75 for HC at baseline (not significant between groups) and 0.50 for placebo vs. 1.75 for HC after 24 h of treatment (p < 0.05)]. These effects were paralleled by respective changes in the phagocytosis-associated H2O2 production.

Conclusions: In patients with septic shock stress doses of HC exert beneficial effects in terms of improvements in hemodynamics, decrease in pro-inflammatory mediators, and oxidative stress without the compromise of opsonization-dependent phagocytic neutrophil functions; thus, HC treatment does not aggravate non-specific immunosuppression but instead improves innate immunity in the early stage of septic shock.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Anti-Inflammatory Agents / administration & dosage*
  • Double-Blind Method
  • Female
  • Hemodynamics / drug effects
  • Humans
  • Hydrocortisone / administration & dosage*
  • Hydrogen Peroxide / metabolism
  • Interleukin-6 / blood
  • Male
  • Middle Aged
  • Neutrophils / drug effects*
  • Neutrophils / metabolism
  • Norepinephrine / administration & dosage
  • Phagocytosis
  • Prospective Studies
  • Shock, Septic / drug therapy*
  • Statistics, Nonparametric


  • Anti-Inflammatory Agents
  • Interleukin-6
  • Hydrogen Peroxide
  • Hydrocortisone
  • Norepinephrine