***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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    Input: Objective To determine the population incidence and outcome of  severe sepsis occurring in adult patients treated in Australian and New Zeal and intensive care units ( ICUs ) , and compare with recent retrospective estimates from the USA and UK . Design Inception cohort study . Setting Twenty-three closed multi-disciplinary ICUs of 21 hospitals ( 16 tertiary and 5 university affiliated ) in Australia and New Zeal and . Patients A total of 5878 consecutive ICU admission episodes . Measurements and results Main outcome measures were population -based incidence of severe sepsis , mortality at ICU discharge , mortality at 28 days after onset of severe sepsis , and mortality at hospital discharge . A total of 691 patients , 11.8 ( 95 % confidence intervals 10.9–12.6 ) per 100 ICU admissions , were diagnosed with 752 episodes of severe sepsis . Site of infection was pulmonary in 50.3 % of episodes and abdominal in 19.3 % of episodes . The calculated incidence of severe sepsis in adults treated in Australian and New Zeal and ICUs is 0.77 ( 0.76–0.79 ) per 1000 of population . 26.5 % of patients with severe sepsis died in ICU , 32.4 % died within 28 days of the diagnosis of severe sepsis and 37.5 % died in hospital . Conclusion In this prospect i ve study , 11.8 patients per 100 ICU admissions were diagnosed with severe sepsis and the calculated annual incidence of severe sepsis in adult patients treated in Australian and New Zeal and ICUs is 0.77 per 1000 of population . This figure for the population incidence falls in the lower range of recent estimates from retrospective studies in the U.S. and the Abstract Introduction Low-dose hydrocortisone treatment is widely accepted therapy for the treatment of vasopressor-dependent septic shock . The question of whether corticosteroids should be given to septic shock patients by continuous or by bolus infusion is still unanswered . Hydrocortisone induces hyperglycemia and it is possible that continuous hydrocortisone infusion would reduce the fluctuations in blood glucose levels and that tight blood glucose control could be better achieved with this approach . Methods In this prospect i ve r and omized study , we compared the blood glucose profiles , insulin requirements , amount of nursing workload needed , and shock reversal in 48 septic shock patients who received hydrocortisone treatment either by bolus or by continuous infusion with equivalent dose ( 200 mg/day ) . Duration of hydrocortisone treatment was five days . Results The mean blood glucose levels were similar in the two groups , but the number of hyperglycemic episodes was significantly higher in those patients who received bolus therapy ( 15.7 ± 8.5 versus 10.5 ± 8.6 episodes per patient , p = 0.039 ) . Also , more changes in insulin infusion rate were needed to maintain strict normoglycemia in the bolus group ( 4.7 ± 2.2 versus 3.4 ± 1.9 adjustments per patient per day , p = 0.038 ) . Hypoglycemic episodes were rare in both groups . No difference was seen in shock reversal . ConclusionS trict normoglycemia is more easily achieved if the hydrocortisone therapy is given to septic shock patients by continuous infusion . This approach also reduces nursing workload needed to maintain tight blood glucose control . Trial Registration Number IS RCT 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 CONTEXT Corticosteroid therapy induces potentially detrimental hyperglycemia in septic shock . In addition , the benefit of adding fludrocortisone in this setting is unclear . OBJECTIVES To test the efficacy of intensive insulin therapy in patients whose septic shock was treated with hydrocortisone  and to assess , as a secondary objective , the benefit of fludrocortisone . DESIGN , SETTING , AND PATIENTS A multicenter , 2 x 2 factorial , r and omized trial , involving 509 adults with septic shock who presented with multiple organ dysfunction , as defined by a Sequential Organ Failure Assessment score of 8 or more , and who had received hydrocortisone treatment was conducted from January 2006 to January 2009 in 11 intensive care units in France . INTERVENTIONS Patients were r and omly assigned to 1 of 4 groups : continuous intravenous insulin infusion with hydrocortisone alone , continuous intravenous insulin infusion with hydrocortisone plus fludrocortisone , conventional insulin therapy with hydrocortisone alone , or conventional insulin therapy with intravenous hydrocortisone plus fludrocortisone . Hydrocortisone was administered in a 50-mg bolus every 6 hours , and fludrocortisone was administered orally in 50-microg tablets once a day , each for 7 days . MAIN OUTCOME MEASURE In-hospital mortality . RESULTS Of the 255 patients treated with intensive insulin , 117 ( 45.9 % ) , and 109 of 254 ( 42.9 % ) treated with conventional insulin therapy died ( relative risk [ RR ] , 1.07 ; 95 % confidence interval [ CI ] , 0.88 - 1.30 ; P = .50 ) . Patients treated with intensive insulin experienced significantly more episodes of severe hypoglycemia ( < 40 mg/dL ) than those in the conventional-treatment group , with a difference in mean number of episodes per patient of 0.15 ( 95 % CI , 0.02 - 0.28 ; P = .003 ) . At hospital discharge , 105 of 245 patients treated with fludrocortisone ( 42.9 % ) died and 121 of 264 ( 45.8 % ) in the control group died ( RR , 0.94 ; 95 % CI , 0.77 - 1.14 ; P = .50 ) . CONCLUSIONS Compared with conventional insulin therapy , intensive insulin therapy did not improve in-hospital mortality among patients who were treated with hydrocortisone for septic shock . The addition of oral fludrocortisone did not result in a statistically significant improvement in in-hospital mortality . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00320099 BACKGROUND Clinical trials yielded conflicting data about the benefit of adding systemic corticosteroids for treatment of community-acquired pneumonia . We assessed whether short-term corticosteroid treatment reduces time to clinical stability in patients admitted to hospital for community-acquired pneumonia . METHODS In this double-blind , multicentre , r and omised , placebo-controlled trial , we recruited patients aged 18 years or older with community-acquired pneumonia from seven tertiary care hospitals in Switzerl and within 24 h of presentation . Patients were r and omly assigned ( 1:1 ratio ) to receive either prednisone 50 mg daily for 7 days or placebo . The computer-generated r and omisation was done with variable block sizes of four to six and stratified by study centre . The primary endpoint was time to clinical stability defined as time ( days ) until stable vital signs for at least 24 h , and analysed by intention to treat . This trial is registered with Clinical Trials.gov , number NCT00973154 . FINDINGS From Dec 1 , 2009 , to May 21 , 2014 , of 2911 patients assessed for eligibility , 785 patients were r and omly assigned to either the prednisone group ( n=392 ) or the placebo group ( n=393 ) . Median time to clinical stability was shorter in the prednisone group ( 3·0 days , IQR 2·5 - 3·4 ) than in the placebo group ( 4·4 days , 4·0 - 5·0 ; hazard ratio [ HR ] 1·33 , 95 % CI 1·15 - 1·50 , p<0·0001 ) . Pneumonia-associated complications until day 30 did not differ between groups ( 11 [ 3 % ] in the prednisone group and 22 [ 6 % ] in the placebo group ; odds ratio [ OR ] 0·49 [ 95 % CI 0·23 - 1·02 ] ; p=0·056 ) . The prednisone group had a higher incidence of in-hospital hyperglycaemia needing insulin treatment ( 76 [ 19 % ] vs 43 [ 11 % ] ; OR 1·96 , 95 % CI 1·31 - 2·93 , p=0·0010 ) . Other adverse events compatible with corticosteroid use were rare and similar in both groups . INTERPRETATION Prednisone treatment for 7 days in patients with community-acquired pneumonia admitted to hospital shortens time to clinical stability without an increase in complications . This finding is relevant from a patient perspective and an important determinant of hospital costs and efficiency . FUNDING Swiss National Science Foundation , Viollier AG , Nora van Meeuwen Haefliger Stiftung , Julia und Gottfried Bangerter-Rhyner Stiftung 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 . There is increasing evidence that the hypercortisolemia in inflammatory diseases suppresses the elaboration of proinflammatory cytokines , thus protecting the host from its own defence reactions . In severe sepsis and septic shock cortisol levels are usually elevated , but some patients may have relative adrenal insufficiency . This may contribute to the overwhelming systemic inflammatory response syndrome . We evaluated the impact of low-dose hydrocortisone infusion 
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Heterogeneity was related in part to the dosing strategy .
Overall , low- quality evidence indicates that corticosteroids reduce mortality among patients with sepsis .
Moderate- quality evidence suggests that a long course of low-dose corticosteroids reduced 28-day mortality without inducing major complications and led to an increase in metabolic disorders