Clinical Management of Endotoxemia: Corticosteroids

In the last decades, corticosteroids have been widely used in septic patients despite hundreds of observational studies and randomized clinical trials (RCTs). Controversies are numerous and potentially due to different therapeutic regimens, patient heterogeneity, type of infection, and great “inter-patient” variability of immune responses to infection (i.e., hyper- versus hypo-inflammatory states). Efficacy and potential risks of corticosteroids in septic patients have not been well assessed. According to the last RCTs, meta-analyses, and updated international guidelines, corticosteroids do not affect short-term and long-term mortality, while they seem to achieve a small reduction in the length of hospital and ICU stay. Corticosteroids are associated with a higher risk of hypernatremia and hyperglycemia, while the effects on superinfection and gastroduodenal bleeding are unclear. Adherence to the current international guidelines for the use of corticosteroids in clinical practice is advisable.