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

Abstract

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.