Glucocorticoid treatment in patients with septic shock: effects on vasopressor use and mortality

Boyer, Alexandre; Chadda, Karim; Salah, Ahmed; Annane, D

doi:10.5414/cpp44309

Cited by 25 publications

(9 citation statements)

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“…[19], who suggested that steroid administration would be more beneficial in patients with documented adrenal insufficiency. However our results are consistent with other studies conducted in different settings, such as in septic shock, showing that the ACTH stimulation test had no predictive value for hemodynamic response of patients receiving corticosteroids [23–26]. …”

Section: Discussionsupporting

confidence: 91%

Interest of low-dose hydrocortisone therapy during brain-dead organ donor resuscitation: the CORTICOME study

et al. 2014

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IntroductionCirculatory failure during brain death organ donor resuscitation is a problem that compromises recovery of organs. Combined administration of steroid, thyroxine and vasopressin has been proposed to optimize the management of brain deceased donors before recovery of organs. However the single administration of hydrocortisone has not been rigorously evaluated in any trial.MethodsIn this prospective multicenter cluster study, 259 subjects were included. Administration of low-dose steroids composed the steroid group (n = 102).ResultsAlthough there were more patients in the steroid group who received norepinephrine before brain death (80% vs. 66%: P = 0.03), mean dose of vasopressor administered after brain death was significantly lower than in the control group (1.18 ± 0.92 mg/H vs. 1.49 ± 1.29 mg/H: P = 0.03), duration of vasopressor support use was shorter (874 min vs. 1160 min: P < 0.0001) and norepinephrine weaning before aortic clamping was more frequent (33.8% vs. 9.5%: P < 0.0001). Using a survival approach, probability of norepinephrine weaning was significantly different between the two groups (P < 0.0001) with a probability of weaning 4.67 times higher in the steroid group than in the control group (95% CI: 2.30 – 9.49).ConclusionsDespite no observed benefits of the steroid administration on primary function recovery of transplanted grafts, administration of glucocorticoids should be a part of the resuscitation management of deceased donors with hemodynamic instability.

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Section: Discussionsupporting

confidence: 91%

Interest of low-dose hydrocortisone therapy during brain-dead organ donor resuscitation: the CORTICOME study

et al. 2014

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“…Interestingly, administration of glucocorticoids was associated with a significantly elevated risk of death, while its clinical implementation jumped from a proportion of 61.5% to 100% across the observed four epidemic waves in this study. Glucocorticoid is mainly used as an anti‐inflammatory agent and is also an alternative for the treatment of septic shock . The administration of glucocorticoids thus reflects disease severity to some extent.…”

Section: Discussionmentioning

confidence: 99%

“…Glucocorticoid is mainly used as an anti-inflammatory agent and is also an alternative for the treatment of septic shock. [29][30][31] The administration of glucocorticoids thus reflects disease severity to some extent. However, as observed in this study, glucocorticoids have been used more and more comprehensively for treating H7N9 patient, not only restricted to these with special need.…”

Section: Discussionmentioning

confidence: 99%

Predictors for fatal human infections with avian H7N9 influenza, evidence from four epidemic waves in Jiangsu Province, Eastern China, 2013‐2016

Huang

Chen

et al. 2017

Influenza Resp Viruses

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BackgroundFour epidemic waves of human infection with H7N9 have been recorded in China up to 1 June 2016, including in Jiangsu Province. However, few studies have investigated the differences in patients' characteristics among the four epidemic waves, and the analyses of factors associated with fatal infection lacked statistical power in previous studies due to limited sample size.MethodsAll laboratory‐confirmed A(H7N9) patients in Jiangsu province were analysed. Patients' characteristics were compared across four waves and between survivors and those who died. Multivariate analyses were used to identify independent predictors of death.ResultsSignificant differences were found in the lengths of several time intervals (from onset of disease to laboratory confirmation, to onset of ARDS and respiratory failure, and to death) and in the development of heart failure. The proportions of overweight patients and rural patients increased significantly across the four waves. Administration of glucocorticoids and double‐dose neuraminidase inhibitors became the norm. Predictors of death included complications such as ARDS, heart failure and septic shock, administration of glucocorticoids, and disease duration.ConclusionCharacteristics of H7N9 patients and clinical treatment options changed over time. Particular complications and the use of particular treatment, along with disease duration, could help clinicians predict the outcome of H7N9 infections.

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“…In addition, by favoring sodium and water accumulation in blood vessels' wall, corticosteroid will contribute to increase systemic vascular resistance. As detailed elsewhere [22], corticosteroids restore within minutes to hours via nongenomic effects vessels sensitivity to alpha agonist with subsequent increase in mean arterial pressure and systemic vascular resistance. They may interfere with activation of ATP-dependent K+ channel [23].…”

Section: Rationale For Using Corticosteroidsmentioning

confidence: 99%

Corticosteroids for severe sepsis: an evidence-based guide for physicians

Annane

2011

Ann. Intensive Care

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Septic shock is characterized by uncontrolled systemic inflammation that contributes to the progression of organ failures and eventually death. There is now ample evidence that the inability of the host to mount an appropriate hypothalamic-pituitary and adrenal axis response plays a major in overwhelming systemic inflammation during infections. Proinflammatory mediators released in the inflamed sites oppose to the anti-inflammatory response, an effect that may be reversed by exogenous corticosteroids. With sepsis, via nongenomic and genomic effects, corticosteroids restore cardiovascular homeostasis, terminate systemic and tissue inflammation, restore organ function, and prevent death. These effects of corticosteroids have been consistently found in animal studies and in most recent frequentist and Bayesian meta-analyses. Corticosteroids should be initiated only in patients with sepsis who require 0.5 μg/kg per minute or more of norepinephrine and should be continued for 5 to 7 days except in patients with poor hemodynamic response after 2 days of corticosteroids and with a cortisol increment of more than 250 nmol/L after a standard adrenocorticotropin hormone (ACTH) test. Hydrocortisone should be given at a daily dose of 200 mg and preferably combined to enteral fludrocortisone at a dose of 50 μg. Blood glucose levels should be kept below 150 mg/dL.

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Glucocorticoid treatment in patients with septic shock: effects on vasopressor use and mortality

Cited by 25 publications

References 0 publications

Interest of low-dose hydrocortisone therapy during brain-dead organ donor resuscitation: the CORTICOME study

Interest of low-dose hydrocortisone therapy during brain-dead organ donor resuscitation: the CORTICOME study

Predictors for fatal human infections with avian H7N9 influenza, evidence from four epidemic waves in Jiangsu Province, Eastern China, 2013‐2016

Corticosteroids for severe sepsis: an evidence-based guide for physicians

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