Effect of stress doses of hydrocortisone on S-100B vs. interleukin-8 and polymorphonuclear elastase levels in human septic shock

Stress doses of hydrocortisone a re known to have immunomodulatory
effects in patients with hyperdynamic septic shock. The prognosis
correlates with the presence and severity of septic encephalopathy.
However, neurological evaluation is influenced by the use of
analgesia sedation during artificial ventilation. The objective of
this study was to demonstrate the effect of stress doses of
hydrocortisone during the initial phase of human septic shock on
the serum values of the neurospecific protein S-100B in comparison
to the inflammation markers interleukin (IL)-8 in serum and
polymorphonuclear (PMN) elastase in plasma. A total of 24
consecutive patients, who met the American College of Chest
Physicians/Society of Critical Care Medicine criteria for septic
shock, were enrolled in this prospective, randomized, double-blind,
single-center trial. The severity of illness at recruitment was
graded using the Acute Physiology and Chronic Health Evaluation 11
and the Simplified Acute Physiology Score 11 scoring systems.
Multi-organ dysfunction syndrome was described by the
Sepsis-related Organ Failure Assessment (SOFA) score. All patients
were prospectively randomized to receive either stress doses of
hydrocortisone or placebo. Hydrocortisone was started in 12
patients with a loading dose of 100 mg and followed by a continuous
infusion of 0.18 mg/kg/h for 6 days. Median S-100B serum levels of
the hydrocortisone group decreased from 0.32 ng/mL at study entry
to 0.07 ng/mL 6 days later without significant differences compared
to the placebo group. Initial IL-8 serum levels were significantly
higher in the hydrocortisone group up to 12 h after study entry,
and significantly decreased from 715 to 17 pg/mL at the end of the
observation period. Median PMN elastase plasma levels were not
affected by hydrocortisone infusion. Patients with initial S-100B
serum levels >0.50 ng/mL revealed significantly higher SOFA
scores up to 30 h, IL-8 serum levels up to 12 h, and PMN elastase
plasma levels up to 36 h after study entry than those patients with