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Semin Respir Crit Care Med
DOI: 10.1055/a-2694-4823
Review Article

Corticosteroid Treatment in Septic Shock

Authors

  • Jiao Liu   ‡

    1   Department of Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Shanghai, China

  • Qian Xing   ‡

    2   Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, China
    3   Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

  • Xiaojun Pan

    1   Department of Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Shanghai, China

  • Sheng Zhang

    1   Department of Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Shanghai, China

  • Dechang Chen

    1   Department of Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Shanghai, China

  • Djillali Annane

    4   Department of Intensive Care, APHP University Versailles Saint Quentin, University Paris Saclay, Raymond Poincaré Hospital, Garches, France
    5   SEPSIS Institute, Institut Hospitalo Universitaire IHU-3, Garches, France
    6   Laboratory of Infection and Inflammation, U1173, School of Medicine, INSERM, University Versailles Saint Quentin, University Paris Saclay, Garches, France
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Abstract

Septic shock, the most severe manifestation of sepsis, is characterized by profound circulatory failure and carries the highest mortality risk among sepsis-related conditions. Current therapeutic strategies remain primarily supportive, emphasizing empirical antimicrobial therapy and advanced organ system support. The immunomodulatory properties of corticosteroids in sepsis pathophysiology have been extensively investigated since the 1970s, though current guidelines recommend corticosteroid therapy for sepsis patients, albeit with a weak evidence base. In this review, we explore the molecular underpinnings of corticosteroid activity in septic shock and clinical evidence from randomized controlled trials, with a special emphasis on the stabilization of hemodynamics and the impact on mortality outcomes. Furthermore, we analyze recent advances in pharmacodynamic understanding that may inform more targeted corticosteroid administration in septic shock.

Keywords

molecular biology - pharmacology - preclinical models - clinical trials - systematic reviews - guidelines

‡ Co-first authors.




Publication History

Received: 14 July 2025

Accepted: 02 September 2025

Article published online:
16 September 2025

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