{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T02:23:16Z","timestamp":1793413396047,"version":"4.5.0"},"reference-count":33,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Steroid supplementation remains controversial in septic shock, partly due to the heterogeneity of the populations studied. Cirrhotic patients with sepsis frequently develop relative adrenal insufficiency, showing poor response to vasopressors and poor prognosis. Early administration of low\u2010dose hydrocortisone might facilitate shock reversal and reduce mortality in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Double\u2010blind, randomised, placebo\u2010controlled multicentre trial, enrolling adult cirrhotic patients with septic shock. Patients were assigned to receive i.v. hydrocortisone (100\u2009mg followed by a continuous infusion of 200\u2009mg\/24\u2009h) or placebo, for at least 3\u2009days, followed by a tapering period of 3\u20137\u2009days, depending on the time of shock resolution. Primary endpoint was 28\u2010day all\u2010cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After enrolment of 83 patients the trial was stopped early due to slow inclusions. Most patients required low\u2010to\u2010moderate doses of vasopressors. There was no difference in 28\u2010day mortality (35% vs. 39.5%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.84) between hydrocortisone and placebo groups. Shock resolution (85% vs. 72.1%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.25) and days to shock resolution [3\u2009days (2.2\u20134; IQR) vs. 4 (2\u20137.5; IQR)] were also similar between groups. More patients receiving placebo died of refractory shock (47.6% vs. 8.7%). No significant differences between treatment arms were observed in shock relapse, new shock episodes or bacterial or fungal superinfections during hospital stay. Hypo\u2010 and hyperglycaemias were more frequent in the hydrocortisone arm. Severity of ACLF at inclusion and inadequacy of empirical antibiotic therapy (HR\u2009=\u20096.40; 95% CI: 3.21\u201312.79) independently predicted 28\u2010day mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Supplemental hydrocortisone did not improve short\u2010term survival in cirrhotic patients with septic shock requiring low\u2010to\u2010moderate doses of vasopressors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>S\u2010number University Hospitals Leuven, Belgium: S55168; EUDRACT: 2010\u2013024273\u201038; Clinicaltrials.gov id: NCT02602210<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70257","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T12:40:48Z","timestamp":1754311248000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Low\u2010Dose Hydrocortisone in Cirrhotic Patients With Septic Shock: A Double\u2010Blind Randomised Placebo\u2010Controlled Trial"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0315-8201","authenticated-orcid":false,"given":"Philippe","family":"Meersseman","sequence":"first","affiliation":[{"name":"Medical Intensive Care Unit, Department of General Internal Medicine University Hospital Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Hern\u00e1ndez\u2010Tejero","sequence":"additional","affiliation":[{"name":"Liver ICU, Liver Unit, IDIBAPS and CIBERehd Hospital Clinic  Barcelona Spain"},{"name":"Division of Gastroenterology and Hepatology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Manuel","family":"Diaz","sequence":"additional","affiliation":[{"name":"EF Clif, EASL\u2010CLIF Consortium  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5983-3897","authenticated-orcid":false,"given":"Joost","family":"Wauters","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, Department of General Internal Medicine University Hospital Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greet","family":"Hermans","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, Department of General Internal Medicine University Hospital Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F\u00e1tima","family":"Aziz","sequence":"additional","affiliation":[{"name":"Liver ICU, Liver Unit, IDIBAPS and CIBERehd Hospital Clinic  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helga","family":"Ceunen","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, Department of General Internal Medicine University Hospital Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Prado","sequence":"additional","affiliation":[{"name":"Liver ICU, Liver Unit, IDIBAPS and CIBERehd Hospital Clinic  Barcelona Spain"},{"name":"Hepato\u2010Gastroenterology Centre Hospitalier de Luxembourg  Luxembourg City Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8564-6809","authenticated-orcid":false,"given":"Lies","family":"Langouche","sequence":"additional","affiliation":[{"name":"Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6896-3843","authenticated-orcid":false,"given":"Mireya","family":"Arteaga","sequence":"additional","affiliation":[{"name":"Liver ICU, Liver Unit, IDIBAPS and CIBERehd Hospital Clinic  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4507-2422","authenticated-orcid":false,"given":"Juan","family":"Acevedo","sequence":"additional","affiliation":[{"name":"Gastroenterology Department University Hospital Plymouth  Plymouth UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2699-5583","authenticated-orcid":false,"given":"Marc","family":"Lleixa","sequence":"additional","affiliation":[{"name":"Liver ICU, Liver Unit, IDIBAPS and CIBERehd Hospital Clinic  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana","family":"Zapatero","sequence":"additional","affiliation":[{"name":"Liver ICU, Liver Unit, IDIBAPS and CIBERehd Hospital Clinic  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5369-6759","authenticated-orcid":false,"given":"David","family":"Toapanta","sequence":"additional","affiliation":[{"name":"Liver ICU, Liver Unit, IDIBAPS and CIBERehd Hospital Clinic  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicente","family":"Arroyo","sequence":"additional","affiliation":[{"name":"EF Clif, EASL\u2010CLIF Consortium  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4176-3608","authenticated-orcid":false,"given":"Alexander","family":"Wilmer","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, Department of General Internal Medicine University Hospital Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5622-0489","authenticated-orcid":false,"given":"Javier","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Liver ICU, Liver Unit, IDIBAPS and CIBERehd Hospital Clinic  Barcelona Spain"},{"name":"EF Clif, EASL\u2010CLIF Consortium  Barcelona Spain"},{"name":"Departament de Medicina, Facultat de Medicina i Ci\u00e8ncies de la Salut Universitat de Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-017-4919-5"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa071366"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.7.862"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1705835"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1705716"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-018-5197-6"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-017-1659-4"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2022.104284"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1214969"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41574\u2010019\u20100185\u20107"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21352"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000164541.12106.57"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0676.2003.00813.x"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.25573"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000001939"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbadis.2018.08.001"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.26535"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2019.09.035"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.10.024"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004193"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.04.021"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21101"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.4997\/jrcpe.2019.405"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.090707"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/1060028019900266"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.07.024"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.04.025"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000005337"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-017-0249-6"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.25931"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-314240"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1210\/jendso\/bvac115"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1441-2772(23)02076-8"}],"container-title":["Liver International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.70257","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T14:07:37Z","timestamp":1764598057000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/liv.70257"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,4]]},"references-count":33,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1111\/liv.70257"],"URL":"https:\/\/doi.org\/10.1111\/liv.70257","archive":["Portico"],"relation":{},"ISSN":["1478-3223","1478-3231"],"issn-type":[{"value":"1478-3223","type":"print"},{"value":"1478-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,4]]},"assertion":[{"value":"2025-02-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70257"}}