Comparison of shock reversal with high or low dose hydrocortisone in intensive care unit patients with septic shock: A retrospective cohort study

Bonnin, Sophia; Radosevich, John; Lee, Yong Gu; Feldman, Jeremy; Barletta, Jeffrey F.

doi:10.1016/j.jcrc.2020.12.001

Cited by 3 publications

(2 citation statements)

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“…The primary outcome was time to reversal of septic shock, defined as a systolic blood pressure (SBP) ≥90 mm Hg or MAP ≥65 mm Hg, sustained for at least 6 hours without the use of vasopressors. 16,17 The time of shock onset was defined as the time at which SBP <90 mm Hg or MAP <65 mm Hg and was considered time zero for all baseline variables. Secondary outcomes included 28-day, 90-day, and in-hospital mortality; ICU and hospital LOS; duration of mechanical ventilation (MV); and time to cardiovascular sepsis-related organ function assessment (SOFA) score < 3.…”

Section: Methodsmentioning

confidence: 99%

“…Only one study, an open-label, randomized controlled trial by the COIITSS study investigators, compared the combination of FC + HC with HC alone as a secondary outcome and found no difference in in-hospital mortality (42.9% vs 45.8%; P = 0.50), vasopressor-free days (4 [2][3][4][5] vs 4 [1][2][3][4][5] days; P = 0.61), or intensive care unit (ICU) (9 [4-16] vs 9 [4-17.5] days; P = 0.86) and hospital length of stay (LOS) (14 [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] vs 18 days; P = 0.15). 15 However, this study was designed to evaluate insulin strategies, and study physicians and nurses were not blinded to corticosteroid group allocation.…”

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confidence: 99%

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Fludrocortisone Plus Hydrocortisone Versus Hydrocortisone Alone as Adjunctive Therapy in Septic Shock: A Retrospective Cohort Study

et al. 2023

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Background: Trials evaluating hydrocortisone (HC) for septic shock are conflicting with all finding decreased time to shock reversal but few with mortality difference. Those with improved mortality included fludrocortisone (FC), but it is unknown if FC affected the outcome or is coincidental as there are no comparative data. Objective: The objective of this study was to determine the effectiveness and safety of FC + HC versus HC alone as adjunctive therapy in septic shock. Methods: A single-center, retrospective cohort study was conducted of medical intensive care unit (ICU) patients with septic shock refractory to fluids and vasopressors. Patients receiving FC + HC were compared with those receiving HC. Primary outcome was time to shock reversal. Secondary outcomes included in-hospital, 28-, and 90-day mortality; ICU and hospital length of stay (LOS); and safety. Results: There were 251 patients included (FC + HC, n = 114 vs HC, n = 137). There was no difference in time to shock reversal (65.2 vs 71 hours; P = 0.24). Cox proportional hazards model showed time to first corticosteroid dose, full-dose HC duration, and use of FC + HC were associated with shorter shock duration, while time to vasopressor therapy was not. However, in 2 multivariable models controlling for covariates, use of FC + HC was not an independent predictor of shock reversal at greater than 72 hours and in-hospital mortality. No differences were seen in hospital LOS or mortality. Hyperglycemia occurred more frequently with FC + HC (62.3% vs 45.6%; P = 0.01). Conclusion and Relevance: FC + HC was not associated with shock reversal at greater than 72 hours or decreased in-hospital mortality. These data may be useful for determining corticosteroid regimen in patients with septic shock refractory to fluids and vasopressors. Future prospective, randomized studies are needed to further evaluate the role of FC in this patient population.

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confidence: 99%

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Fludrocortisone Plus Hydrocortisone Versus Hydrocortisone Alone as Adjunctive Therapy in Septic Shock: A Retrospective Cohort Study

et al. 2023

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Occurrence, analysis and removal of pesticides, hormones, pharmaceuticals, and other contaminants in soil and water streams for the past two decades: a review

Kanan

Moyet²,

Obeideen³

et al. 2022

Res Chem Intermed

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Effect of fixed-dose hydrocortisone on vasopressor dose and mean arterial pressure in obese and nonobese patients with septic shock

Lenney

Kopp

Erstad

2022

American Journal of Health-System Pharmacy

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Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Several studies have shown hydrocortisone to be beneficial in the treatment of vasopressor-refractory septic shock, but there are minimal data evaluating the efficacy of this fixed dosing regimen in overweight and obese patients. The purpose of this study was to compare the effects of fixed-dose hydrocortisone on vasopressor dose and mean arterial pressure in obese and nonobese patients with septic shock refractory to adequate fluid resuscitation and vasopressor administration. Methods In this multicenter, retrospective study, we included adult patients with a confirmed or suspected diagnosis of septic shock who received hydrocortisone (200 mg/day). Patients were divided into 4 study groups based on admission body mass index (BMI; defined as BMI of <25 kg/m 2, 25-29.9 kg/m 2, 30-34.9 kg/m 2, and ≥35 kg/m 2). The primary outcomes analyzed were change in norepinephrine equivalent dose requirements and mean arterial pressure (MAP) at 6, 12, and 24 hours after initiating hydrocortisone. Results Between October 1, 2017, and September 30, 2020, 431 patients were screened of whom 219 met inclusion criteria. Baseline characteristics were comparable among the groups. Mean vasopressor requirements (in ΀g/min) at 6, 12, and 24 hours were as follows: BMI of <25 kg/m 2:  28.8, 24.8, and 20; BMI of 25-29.9 kg/m 2: 34.1, 33.5, and 24.8; BMI of 30-34.9 kg/m 2: 29.5, 33.5, and 24.8; and BMI of ≥35≥kg/m 2: 32, 25.7 and, 21.2 (P = 0.75, 0.41, and 0.61, respectively). Mean MAP (in mm Hg) at 6, 12, and 24 hours was as follows: BMI of <25 kg/m 2:  73.5, 73.6, and 74; BMI of 25-29.9 kg/m 2: 71.6, 73.8, and 71.9; BMI of 30-34.9 kg/m 2: 72.2, 70, and 72.7; and BMI of ≥35 kg/m 2: 70.7, 73.5, and 71.4 (P = 0.56, 0.15, and 0.62, respectively). Conclusion BMI does not appear to impact the effects of fixed-dose hydrocortisone on vasopressor dose or blood pressure in patients with septic shock. Fixed-dose hydrocortisone should continue to be used for vasopressor-refractory septic shock in obese patients.

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Comparison of shock reversal with high or low dose hydrocortisone in intensive care unit patients with septic shock: A retrospective cohort study

Cited by 3 publications

References 22 publications

Fludrocortisone Plus Hydrocortisone Versus Hydrocortisone Alone as Adjunctive Therapy in Septic Shock: A Retrospective Cohort Study

Fludrocortisone Plus Hydrocortisone Versus Hydrocortisone Alone as Adjunctive Therapy in Septic Shock: A Retrospective Cohort Study

Occurrence, analysis and removal of pesticides, hormones, pharmaceuticals, and other contaminants in soil and water streams for the past two decades: a review

Effect of fixed-dose hydrocortisone on vasopressor dose and mean arterial pressure in obese and nonobese patients with septic shock

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