Although corticosteroids clearly have beneficial effects on shock duration their impact on patient survival is less clear.

The differences in mortality effects seen in past clinical trials could be explained by different transcriptomic endotypes expressed by the included patients, leading to differential responses to corticosteroid treatment.

To account for these differential responses future trials should aim to stratify patients according to their RNA expression endotypes so that subgroups who may respond positively to corticosteroids can be identified and those who may come to harm can avoid this treatment.

As RNA endotypes cannot be assigned using clinical parameters alone, we urgently need rapid diagnostic tests to better characterize our patients and select optimal, personalized treatments, whether they be “old” drugs, such as corticosteroids, or “new” immunotherapies.

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