A double-edged sword: a narrative review on steroids in sepsis and septic shock

Sepsis and septic shock are life-threatening conditions characterized by a dysregulated host response to infection. Although corticosteroids, particularly hydrocortisone, promote positive effects on hemodynamic stability in septic shock, the efficacy of these drugs remains controversial. In this narrative review, we aimed at appraising the actual role of corticosteroids focusing specifically on septic shock. We conducted a comprehensive search of the recent literature, including randomized controlled trials, meta-analyses, and current clinical guidelines, to evaluate the role of corticosteroids in the management of septic shock. Studies were evaluated to determine the impact on mortality, hemodynamics, and other clinical outcomes. The studies showed variability in dosing and time of administration as well as patient selection, which highlighted the lack of a standardized treatment approach. While corticosteroids improved short-term hemodynamic outcomes and reduced vasopressor requirement, their effect on long-term survival was minimal. These results led current guidelines to a weak recommendation for hydrocortisone use in septic shock patients with persistent hypotension despite adequate fluid resuscitation and vasopressor therapy. Corticosteroids, e.g. hydrocortisone, can be beneficial in managing septic shock, but their role remains uncertain. Further research is needed to refine treatment protocols and determine the optimal patient selection for corticosteroid therapy.