Low-dose steroid therapy does not affect hemodynamic response in septic shock patients

• Published in: Journal of critical care 2007-12, Vol.22 (4), p.324-329
• Main Authors: Raurich, Joan M., MD, PhD, Llompart-Pou, Juan A., MD, Ibáñez, Jordi, MD, PhD, Frontera, Guillem, MD, Pérez, Olatz, MD, García, Laura, MD, Ayestarán, José I., MD
• Format: Article
• Language: English
• Subjects: Adrenal glands; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - pharmacology; Cortisol; Critical Care; Female; Fludrocortisone - administration & dosage; Fludrocortisone - pharmacology; Hemodynamics - drug effects; Humans; Hydrocortisone - administration & dosage; Hydrocortisone - pharmacology; Low-dose steroid therapy; Male; Middle Aged; Mortality; Multivariate Analysis; Propensity score; Proportional Hazards Models; Retrospective Studies; Septic shock; Shock reversal; Shock, Septic - drug therapy; Shock, Septic - physiopathology; Steroids; Studies; Survival Analysis
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2007.05.005

Abstract Purpose Several studies showed that low-dose steroid therapy (LDST) in patients with septic shock leads to a significantly shorter duration of shock and a decreased mortality. However, these results have been criticized. Our purpose was to evaluate the effects of LDST on time to shock reversal and mortality in septic shock. Materials and Methods We retrospectively studied 203 patients with septic shock admitted to the intensive care unit of our tertiary hospital. A short corticotropin test was performed in all patients within 72 hours of septic shock onset. We performed a propensity score analysis through a logistic regression model with baseline relevant characteristics, and evaluated the influence of LDST on time to shock reversal and inhospital mortality. Results One hundred twenty-four patients were treated with LDST (steroid group) and 79 without LDST (control group). Patients treated with steroids presented higher Simplified Acute Physiology Score II and maximum Sepsis-Related Organ Failure Assessment scores. Both groups presented similar baseline and stimulated cortisol values. The hazard ratio of remaining on shock adjusted by severity of illness, inadequate antibiotic, and propensity score was 1.15 (95% confidence interval 0.71-1.86) for patients treated with steroids. Inhospital mortality was 62% in the steroid group and 52% in the control group ( P = .84). Logistic regression analysis with propensity score neither showed differences between steroid and control group in the inhospital mortality. Predictors of inhospital mortality were age, maximum Sepsis-Related Organ Failure Assessment score, and inadequate antibiotics. Conclusion In our study, treatment with low-dose steroid therapy was not associated to a reduction in time to shock reversal or mortality.