Using Corticosteroids in Intensive Care—Reply

In reply

We appreciate the interest of Dr Marik and colleagues, Dr Salluh, and Dr Marx in our article. The retrospective design of our article does lead to some difficulty in interpreting the multidimensional outcomes associated with critical illness. Seventy-five percent of our steroid group received low-dose steroids with 57 patients receiving dexamethasone and 18 patients receiving hydrocortisone. Twenty-five of the patients, all with spinal cord injuries, received high-dose solumedrol. Interestingly, the type of steroid was not predictive of infection with multivariate analysis, although the numbers in each group are low. Twenty-three of our patients received steroids for “adrenal insufficiency” not related to sepsis with 6 patients treated for relative adrenal insufficiency in the setting of septic shock. All 29 patients were diagnosed by a random cortisol level of less than 25 μg/dL. Eleven of the patients had a high-dose cortisol stimulation test with an inappropriate adrenal response, including all 6 of the patients with septic shock.