Journal Club Summary

Methodology: 3/5
Usefulness: 3.5/5

Annane D, et al. N Engl J Med. 2018 Mar 1;378(9):809-818. 

Editorial: A Role for Hydrocortisone Therapy in Septic Shock?

Question and Methods: Large multi-center, double-blinded, randomized-controlled trial comparing effects of steroids (fludrocortisone + hydrocortisone) to placebo on 90-day mortality of ICU patients in septic shock on vasopressors for at least 6 hours.

Findings: Use of steroids reduced 90-day mortality (43% vs 49.1% for placebo, p=0.03), with a NNT = 17. There were no differences in rates of serious adverse events.

Limitations: Original study design had to be changed partway, could not study one of the intended drugs (Activated Protein C). Results of the corticotropin tests were not reported.

Interpretation: Given primary outcome findings, statistically significant secondary outcomes, and safety profile, in patients with septic shock requiring vasopressors for at least 6 hours, clinicians should be using steroids (hydrocortisone and fludrocortisone).

By: Dr. Sarah Taissir-Bencharif


Epi Lesson

Survival Analyses
Survival analyses are used in clinical trials that follow patients over time for primary outcomes such as death, relapse, adverse drug reaction, or development of a new disease. The follow-up time may range from hours to years and a different set of statistical procedures are employed to analyze the data. Terms frequently seen in papers with survival analyses include Cox proportional hazard model, hazard ratio, Kaplan-Meir curve.

By: Dr. Venkatesh Thiruganasambandamoorthy


  • Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.