Effect of corticosteroids on nuclear factor-κB activation and hemodynamics in late septic shock

Objective To describe the underlying pathophysiologic mechanisms of the effect of corticosteroids in a patient with late septic shock. Design Case report. Setting The medical intensive care unit at University Medical Center Utrecht. Patient An 86-yr-old female patient with late septic shock requiring mechanical ventilation and vasopressive agents. Interventions Administration of hydrocortisone, 300 mg daily. Measurements and main results Within 3 days of corticosteroid treatment, the patient could be weaned of vasopressive agents and mechanical ventilation. Serum C-reactive protein levels normalized. Nuclear factor-kappaB activation in unstimulated and in vitro lipopolysaccharide-stimulated peripheral blood mononuclear cells decreased to background level within 5 days. Repeated functional tests of the hypothalamic-pituitary-adrenal axis were normal. Conclusion Our data suggest that the pathophysiologic mechanism behind the clinical effects of supraphysiologic doses of corticosteroids in late septic shock is directly related to the inhibition of nuclear factor-kappaB in peripheral blood mononuclear cells.