Hyperglycemia risk evaluation of hydrocortisone intermittent boluses versus continuous infusion in septic shock: A prospective randomized trial

Abstract

Background: Hydrocortisone showed an important role in reversal of shock when added to standard therapy in managing septic shock. Hyperglycemia is one of the most common side effects associated with corticosteroid treatment. Aims: This study aimed to evaluate the risk of hyperglycemia of intermittent hydrocortisone boluses versus continuous infusion in septic shock patients. Settings and Design: This was a prospective randomized controlled study conducted in a tertiary care teaching hospital. Materials and Methods: One hundred and forty patients with septic shock and who received noradrenaline were enrolled in this randomized study. Group 1 was intermittent bolus hydrocortisone group ( n = 70) and Group 2 was continuous infusion group ( n = 70). All patients who were admitted with septic shock and who received noradrenaline and hydrocortisone were included in the study. Those patients who had exceeded 200 mg per day of hydrocortisone were excluded from the study. The primary outcome of the study was mean blood glucose. Statistical Analysis Used: Qualitative variables were compared between the two groups with the Chi-square of the Fisher's exact test and continuous variables were compared using the Student's t -test or the Wilcoxon rank-sum test. Results: Out of 112 patients, 54 patients received hydrocortisone as intermittent boluses (48.2%), and 58 patients (51.8%) received continuous infusion. For the primary outcome, no statistically or clinically significant difference was found in the blood glucose estimated marginal mean: 154.44 mg.dL −1 (95% confidence interval [CI]: 144.18–166.88) in the bolus group and 160.2 mg.dL −1 (95% CI: 143.82–176.76) in the infusion group with a mean difference of 05.76 mg.dL −1 (95% CI: −13.86–25.38). For the secondary outcomes of the study, no difference was found between the two groups in hyperglycemic or hypoglycemic events, mortality, length of stay in intensive care unit, and reversal of shock. Conclusions: The risk of hyperglycemia is almost equal in both intermittent and continuous infusions of hydrocortisone in septic shock patients.

Steroid therapy for patients with septic shock: A multicenter observational study conducted in Japan

“…It is possible that the prognosis may be associated with the choice of intermittent or continuous infusion; however, further studies are needed. As has been seen in this study and previously reported RCTs (13)(14)(15)(16)(17), barriers in conducting the study that targeted patients with septic shock, a subgroup of sepsis, include securing a sufficient number of subjects. It could also be burdensome to collect detailed data on medications to examine this research question.…”

“…Although the effectiveness of steroids has been demonstrated, the best method of steroid administration remains to be elucidated. Several randomized controlled trials (RCTs) have investigated whether the intermittent or continuous infusion of steroids improves the patient prognosis (13)(14)(15)(16)(17). Regarding shock reversal, the results from these RCTs were controversial: namely, continuous infusion was better in one study (13), intermittent infusion was better in another study (14), and there was no difference between the two infusion methods in the other two studies (15)(16)(17).…”