Corticosteroid - an uncertainty in management of sepsis

Sepsis is defined as systemic response to infection and is diagnosed as per ACCS/SCCP consensus conference committee, 1992 guidelines.[1] Progression of sepsis to septic shock is caused by series of immune responses.[2] For many decades in the past steroids have been used in the management of sepsis but there has been an ambiguity in their use in septic shock, doses, duration of therapy effectiveness. However, recent studies have shown it to be effective in septic shock associated with “relative adrenal insufficiency”.[3] Cortisol increases at times of physiological stresses (e.g. sepsis, major injury, surgery, burns) due to activation of the hypothalamus pituitary axis. Suboptimal cortisol production during the septic shock has been termed as relative adrenal insufficiency and has been related to increased mortality in patients with sepsis but its actual existence remains controversial. The biochemical diagnosis of adrenal insufficiency by adrenocorticotropic hormone (ACTH) tests were thought to be unreliable in critically ill patients. Also, measuring total cortisol may not be accurate in severely ill patients due to fluctuating levels of cortisol binding globulins.[4,5]