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To the Editor: Dr Annane and colleagues¹ claim that corticotropin nonresponders with septic shock who were treated with corticosteroids had a significantly decreased mortality. This claim is based on an adjusted Cox model that corrects for baseline cortisol, cortisol response to tetracosactin, McCabe classification, Logistic Organ Dysfunction score, arterial lactate concentration, and PAO₂/Fio₂. The authors were able to show a modest decrease in mortality only after correcting for these factors.

The ² tests on the 28-day mortality for the study group as a whole and without adjustment for covariates did not reveal significant differences, however. Thus, the authors could have concluded that they failed to demonstrate a survival advantage. Randomization should have evened out differences between the placebo and treatment groups, but the authors chose to factor in many confounders and as a result claim a survival advantage for nonresponders. In a pragmatic trial such as this, the most . . . [Full Text of this Article]

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