***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: CONTEXT AND OBJECTIVE Sepsis and septic shock are very common conditions among critically ill patients that lead to multiple organ dysfunction syndrome ( MODS ) and death . Our purpose was to investigate the efficacy of early administration of dexamethasone for patients with septic shock , with the aim of halting the progression towards MODS and death . DESIGN AND SETTING Prospect i ve , r and omized , double-blind , single-center study , developed in a surgical intensive care unit at Hospital das Clínicas , Faculdade de Medicina da Universidade de São Paulo . METHODS The study involved 29 patients with septic shock . All eligible patients were prospect ively r and omized to receive either a dose of 0.2 mg/kg of dexamethasone ( group D ) or placebo ( group P ) , given three times at intervals of 36 hours . The patients were monitored over a seven-day period by means of the sequential organ failure assessment score . RESULTS Patients treated with dexamethasone did not require vasopressor therapy for as much time over the seven-day period as did the placebo group ( p = 0.043 ) . Seven-day mortality was 67 % in group P ( 10 out of 15 ) and 21 % in group D ( 3 out of 14 ) ( relative risk = 0.31 , 95 % confidence interval 0.11 to 0.88 ) . Dexamethasone enhanced the effects of vasopressor drugs . CONCLUSIONS Early treatment with dexamethasone reduced the seven-day mortality among septic shock patients and showed a trend towards reduction of 28-day mortality BACKGROUND Septic shock is characterized by dysregulation of the host response to infection , with circulatory , cellular , and metabolic abnormalities . We hypothesized that therapy with hydrocortisone plus fludrocortisone or with drotrecogin alfa ( activated ) , which can modulate the host response , would improve the clinical outcomes of patients with septic shock . METHODS In this multicenter , double‐blind , r and omized trial with a 2‐by‐2 factorial design , we evaluated the effect of hydrocortisone‐plus‐fludrocortisone therapy , drotrecogin alfa ( activated ) , the combination of the three drugs , or their respective placebos . The primary outcome was 90‐day all‐cause mortality . Secondary outcomes included mortality at intensive care unit ( ICU ) discharge and hospital discharge and at day 28 and day 180 and the number of days alive and free of vasopressors , mechanical ventilation , or organ failure . After drotrecogin alfa ( activated ) was withdrawn from the market , the trial continued with a two‐group parallel design . The analysis compared patients who received hydrocortisone plus fludrocortisone with those who did not ( placebo group ) . RESULTS Among the 1241 patients included in the trial , the 90‐day mortality was 43.0 % ( 264 of 614 patients ) in the hydrocortisone‐plus‐fludrocortisone group and 49.1 % ( 308 of 627 patients ) in the placebo group ( P=0.03 ) . The relative risk of death in the hydrocortisone‐plus‐fludrocortisone group was 0.88 ( 95 % confidence interval , 0.78 to 0.99 ) . Mortality was significantly lower in the hydrocortisone‐plus‐fludrocortisone group than in the placebo group at ICU discharge ( 35.4 % vs. 41.0 % , P=0.04 ) , hospital discharge ( 39.0 % vs. 45.3 % , P=0.02 ) , and day 180 ( 46.6 % vs. 52.5 % , P=0.04 ) but not at day 28 ( 33.7 % and 38.9 % , respectively ; P=0.06 ) . The number of vasopressor‐free days to day 28 was significantly higher in the hydrocortisone‐plus‐fludrocortisone group than in the placebo group ( 17 vs. 15 days , P<0.001 ) , as was the number of organ‐failure – free days ( 14 vs. 12 days , P=0.003 ) . The number of ventilator‐free days was similar in the two groups ( 11 days in the hydrocortisone‐plus‐fludrocortisone group and 10 in the placebo group , P=0.07 ) . The rate of serious adverse events did not differ significantly between the two groups , but hyperglycemia was more common in hydrocortisone‐plus‐fludrocortisone group . CONCLUSIONS In this trial involving patients with septic shock  , 90‐day all‐cause mortality was lower among those who received hydrocortisone plus fludrocortisone than among those who received placebo . ( Funded by Programme Hospitalier de Recherche Clinique 2007 of the French Ministry of Social Affairs and Health ; APROCCHSS Clinical Trials.gov number , NCT00625209 . Background Authors of recent meta-analyses have reported that prolonged glucocorticoid treatment is associated with significant improvements in patients with severe pneumonia or acute respiratory distress syndrome ( ARDS ) of multifactorial etiology . A prospect i ve r and omized trial limited to patients with sepsis-associated ARDS is lacking . The objective of our study was to evaluate the efficacy of hydrocortisone treatment in sepsis-associated ARDS . Methods In this double-blind , single-center ( Siriraj Hospital , Bangkok ) , r and omized , placebo-controlled trial , we recruited adult patients with severe sepsis within 12 h of their meeting ARDS criteria . Patients were r and omly assigned ( 1:1 ratio ) to receive either hydrocortisone 50 mg every 6 h or placebo . The primary endpoint was 28-day all-cause mortality ; secondary endpoints included survival without organ support on day 28 . Results Over the course of 4 years , 197 patients were r and omized to either  hydrocortisone  ( n = 98 ) or placebo ( n = 99 ) and were included in this intention-to-treat analysis . The treatment group had significant improvement in the ratio of partial pressure of oxygen in arterial blood to fraction of inspired oxygen and lung injury score ( p = 0.01 ) , and similar timing to removal of vital organ support ( HR 0.74 , 95 % CI 0.51–1.07 ; p = 0.107 ) . After adjustment for significant covariates , day 28 survival was similar for the whole group ( HR 0.80 , 95 % CI 0.46–1.41 ; p = 0.44 ) and for the larger subgroup ( n = 126 ) with Acute Physiology and Chronic Health Evaluation II score < 25 ( HR 0.57 , 95 % CI 0.24–1.36 ; p = 0.20 ) . With the exception of hyperglycemia ( 80.6 % vs. 67.7 % ; p = 0.04 ) , the rate of adverse events was similar . Hyperglycemia had no impact on outcome . Conclusions In sepsis-associated ARDS , hydrocortisone treatment was associated with a significant improvement in pulmonary physiology , but without a significant survival benefit . Trial registration Clinical Trials.gov identifier NCT01284452 . Registered on 18 January 2011 Background Recent studies have reported a high prevalence of relative adrenal insufficiency in patients with liver cirrhosis . However , the effect of corticosteroid replacement on mortality in this high-risk group remains unclear . We examined the effect of low-dose hydrocortisone in patients with cirrhosis who presented with septic shock . Methods We enrolled patients with cirrhosis and septic shock aged 18 years or older in a r and omized double-blind placebo-controlled trial . Relative adrenal insufficiency was defined as a serum cortisol increase of less than 250 nmol/L or 9 μg/dL from baseline after stimulation with 250 μg of intravenous corticotropin . Patients were assigned to receive 50 mg of intravenous hydrocortisone or placebo every six hours until hemodynamic stability was achieved , followed by steroid tapering over eight days . The primary outcome was 28-day all-cause mortality . Results The trial was stopped for futility at interim analysis after 75 patients were enrolled . Relative adrenal insufficiency was diagnosed in 76 % of patients . Compared with the placebo group ( n = 36 ) , patients in the hydrocortisone group ( n = 39 ) had a significant reduction in vasopressor doses and higher rates of shock reversal ( relative risk [ RR ] 1.58 , 95 % confidence interval [ CI ] 0.98–2.55 , p = 0.05 ) . Hydrocortisone use was not associated with a reduction in 28-day mortality ( RR 1.17 , 95 % CI 0.92–1.49 , p = 0.19 ) but was associated with an increase in shock relapse ( RR 2.58 , 95 % CI 1.04–6.45 , p = 0.03 ) and gastrointestinal bleeding ( RR 3.00 , 95 % CI 1.08–8.36 , p = 0.02 ) . Interpretation Relative adrenal insufficiency was very common in patients with cirrhosis presenting with septic shock . Despite initial favourable effects on hemodynamic  parameters , hydrocortisone therapy did not reduce mortality and was associated with an increase in adverse effects . ( Current Controlled Trials registry no. IS RCT N99675218 . BACKGROUND In sub-Saharan Africa , bacterial meningitis is common and is associated with a high mortality .  Adjuvant therapy with corticosteroids reduces mortality among adults in the developed world , but it has not been adequately tested in developing countries or in the context of advanced human immunodeficiency virus ( HIV ) infection . METHODS We conducted a r and omized , double-blind , placebo-controlled trial of dexamethasone ( 16 mg twice daily for 4 days ) and an open-label trial of intramuscular versus intravenous ceftriaxone ( 2 g twice daily for 10 days ) in adults with an admission diagnosis of bacterial meningitis in Blantyre , Malawi . The primary outcome was death at 40 days after r and omization . RESULTS A total of 465 patients , 90 % of whom were HIV-positive , were r and omly assigned to receive dexamethasone ( 233 patients ) or placebo ( 232 patients ) plus intramuscular ceftriaxone ( 230 patients ) or intravenous ceftriaxone ( 235 patients ) . There was no significant difference in mortality at 40 days in the corticosteroid group ( 129 of 231 patients ) as compared with the placebo group ( 120 of 228 patients ) by intention-to-treat analysis ( odds ratio , 1.14 ; 95 % confidence interval [ CI ] , 0.79 to 1.64 ) or when the analysis was restricted to patients with proven pneumococcal meningitis ( 68 of 129 patients receiving corticosteroids vs. 72 of 143 patients receiving placebo ) ( odds ratio , 1.10 ; 95 % CI , 0.68 to 1.77 ) . There were no significant differences between groups in the outcomes of disability and death combined , hearing impairment , and adverse events . There was no difference in mortality with intravenous ceftriaxone ( 121 of 230 patients ) as compared with intramuscular ceftriaxone ( 128 of 229 patients ) ( odds ratio , 0.88 ; 95 % CI , 0.61 to 1.27 ) . CONCLUSIONS Adjuvant therapy with dexamethasone for bacterial meningitis in adults from an area with a high prevalence of HIV did not reduce mortality or morbidity . In this setting , intramuscular administration was not inferior to intravenous administration of ceftriaxone for bacterial meningitis . ( Current Controlled Trials number , IS RCT N31371499 [ controlled-trials.com ] . ) Introduction The aim of the study was to assess the prognostic importance of basal cortisol concentrations and cortisol response to corticotropin , and to determine the effects of physiological dose steroid therapy on mortality in patients with sepsis . Methods Basal cortisol level and corticotropin stimulation test were performed within 24 hours in all patients . One group ( 20 patients ) received st and ard therapy for sepsis and physiological-dose steroid therapy for 10 days ; the other group ( 20 patients ) received only st and ard therapy for sepsis .  Basal cortisol level was measured on the 14th day in patients who recovered . The outcome of sepsis was compared . Results Only Sequential Organ Failure Assessment ( SOFA ) score was found related to mortality , independent from other factors in multivariate analysis . No significant difference was found between the changes in the percentage of SOFA scores of the  steroid therapy group and the st and ard therapy group in survivors , nor between the groups in basal and peak cortisol levels , cortisol response to corticotropin test and mortality . The mortality rates among patients with occult 
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Conclusions and Relevance The findings suggest that administration of corticosteroids is associated with reduced 28-day mortality compared with placebo use or st and ard supportive care .