Aldosterone secretion in patients with septic shock: a prospective study

Moraes, Rafael Barberena; Friedman, Gilberto; Viana, Marina Verçoza; Tonietto, Tiago Antônio; Saltz, Henrique; Czepielewski, Mauro Antônio

doi:10.1590/s0004-27302013000800009

Cited by 12 publications

(13 citation statements)

References 20 publications

(18 reference statements)

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“…Prior work suggests that decreased effective circulating volume and renin activity, rather than potassium or adrenocorticotropin, are the primary regulators of the aldosterone level during critical illness. 41 Our results suggest that for the FACTT patients with higher initial aldosterone levels (lower effective circulating volume), the potential risks of fluid administration were balanced by the potential benefits in improving effective circulating volume. In contrast, for FACTT patients with lower initial aldosterone levels (higher effective circulating volume), diuresis and prevention of fluid administration appear to have improved mortality.…”

Section: Discussionmentioning

confidence: 69%

B-Type Natriuretic Peptide, Aldosterone, and Fluid Management in ARDS

Semler

Marney²,

Rice

et al. 2016

Chest

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Section: Discussionmentioning

confidence: 69%

B-Type Natriuretic Peptide, Aldosterone, and Fluid Management in ARDS

Semler

Marney²,

Rice

et al. 2016

Chest

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“…The plasma concentrations of aldosterone were found to be unexpectedly low in meningococcal sepsis compared with ICU admissions for other reasons ( 141 ). Lower than expected aldosterone levels have also been reported in adults’ septic shock ( 142 , 143 ). Inappropriately low aldosterone levels during septic shock were associated with increased ICU length of stay, an increased incidence of acute kidney failure ( 144 ), and increased mortality ( 145 ).…”

Section: Immunomodulation In Sepsismentioning

confidence: 74%

Immune Effects of Corticosteroids in Sepsis

et al. 2018

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Sepsis, a life-threatening organ dysfunction, results from a dysregulated host response to invading pathogens that may be characterized by overwhelming systemic inflammation or some sort of immune paralysis. Sepsis remains a major cause of morbidity and mortality. Treatment is nonspecific and relies on source control and organ support. Septic shock, the most severe form of sepsis is associated with the highest rate of mortality. Two large multicentre trials, undertaken 15 years apart, found that the combination of hydrocortisone and fludrocortisone significantly reduces mortality in septic shock. The corticosteroids family is composed of several molecules that are usually characterized according to their glucocorticoid and mineralocorticoid power, relative to hydrocortisone. While the immune effects of glucocorticoids whether mediated or not by the intracellular glucocorticoid receptor have been investigated for several decades, it is only very recently that potential immune effects of mineralocorticoids via non-renal mineralocorticoid receptors have gained popularity. We reviewed the respective role of glucocorticoids and mineralocorticoids in counteracting sepsis-associated dysregulated immune systems.

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“…Animal studies found an association between sepsis and the downregulation of the MR in endothelial cells [50], and mineralocorticoid supplementation lowered IL-6 levels, hastened shock reversal, and improved survival [51,52]. Some clinical studies also revealed inappropriately low aldosterone levels in patients with septic shock, suggesting an impaired adrenal synthesis of aldosterone, that might be associated with increased mortality [41,53]. Although the direct effect of mineralocorticoids in septic patients has not been fully elucidated, our results support a recommendation for the dual administration of hydrocortisone and fludrocortisone to patients with septic shock.…”

Section: Discussionmentioning

confidence: 99%

“…While hydrocortisone has been extensively examined in sepsis, fludrocortisone has been used for patients with aldosterone deficiency, and the dual administration of these two medications is recommended for some patients with primary adrenal insufficiency [39,40]. Considering that patients with septic shock have been found to have unexpectedly low aldosterone levels due to HPA axis abnormalities [41], dual treatment with hydrocortisone and fludrocortisone should be further validated as a type of corticosteroid treatment for septic shock.…”

Section: Introductionmentioning

confidence: 99%

Hydrocortisone with Fludrocortisone for Adult Patients with Septic Shock: A Systematic Review and Meta-Analysis

Yamamoto¹,

Nahara²,

Toyosaki³

et al. 2020

Preprint

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Background : The efficacy of corticosteroids for patients with septic shock remains controversial. Therefore, evaluating a specific corticosteroid treatment could solve the conflicting results of past studies. We performed this systematic review and meta-analysis to elucidate the beneficial effects of a dual corticosteroid treatment regime involving administration of both hydrocortisone and fludrocortisone for adult patients with septic shock on mortality.Methods : We searched the Medline, Cochrane CENTRAL, and ICHUSHI databases from inception to April 2019. We included peer-reviewed randomized controlled trials that compared the use of both hydrocortisone and fludrocortisone with either corticosteroid-free or hydrocortisone-only treatments on adult patients with septic shock. Three researchers independently reviewed the studies for design, eligibility criteria of patients, dose of each corticosteroid, and duration of corticosteroid therapy following PRISMA guidelines. The random-effects models and Grading of Recommendations Assessment, Development and Evaluation were applied to rate the quality of the evidence. Primary outcome was 28-day mortality, and secondary outcomes were in-hospital mortality, long-term mortality, shock reversal, and adverse events. Results : Among the four studies eligible for data synthesis, we included 2050 patients from three studies for quantitative synthesis. All studies used similar regimens (50 mg intravenous bolus of hydrocortisone every 6 h and 50 μg tablets of fludrocortisone once daily for 7 days without tapering). The 28-day mortality rate was reduced after dual corticosteroid treatment [risk ratio, 0.88; 95% confidence intervals (CI), 0.78–0.99]. The heterogeneity between the studies was low (I² = 0%). Furthermore, the certainty in the effect estimates was high. Patients that underwent dual corticosteroid treatment had lower long-term mortality rates (RR, 0.90, 95% CI, 0.83–0.98) and higher rate of shock reversal after 28 days (odds ratio, 1.06; 95% CI, 1.01–1.12) than control patients. Adverse events (except for hyperglycemia) were similar among the treatment groups.Conclusions : The available evidence suggests that a combination of fludrocortisone and hydrocortisone is more effective than adjunctive therapy and may be recommended for patients with septic shock.

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Aldosterone secretion in patients with septic shock: a prospective study

Cited by 12 publications

References 20 publications

B-Type Natriuretic Peptide, Aldosterone, and Fluid Management in ARDS

B-Type Natriuretic Peptide, Aldosterone, and Fluid Management in ARDS

Immune Effects of Corticosteroids in Sepsis

Hydrocortisone with Fludrocortisone for Adult Patients with Septic Shock: A Systematic Review and Meta-Analysis

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