Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 16 (1), R3

Early Initiation of Low-Dose Corticosteroid Therapy in the Management of Septic Shock: A Retrospective Observational Study

Affiliations

Early Initiation of Low-Dose Corticosteroid Therapy in the Management of Septic Shock: A Retrospective Observational Study

Hye Yun Park et al. Crit Care.

Abstract

Introduction: The use of low-dose steroid therapy in the management of septic shock has been extensively studied. However, the association between the timing of low-dose steroid therapy and the outcome has not been evaluated. Therefore, we evaluated whether early initiation of low-dose steroid therapy is associated with mortality in patients with septic shock.

Methods: We retrospectively analyzed the clinical data of 178 patients who received low-dose corticosteroid therapy for septic shock between January 2008 and December 2009. Time-dependent Cox regression models were used to adjust for potential confounding factors in the association between the time to initiation of low-dose corticosteroid therapy and in-hospital mortality.

Results: The study population consisted of 107 men and 71 women with a median age of 66 (interquartile range, 54 to 71) years. The 28-day mortality was 44% and low-dose corticosteroid therapy was initiated within a median of 8.5 (3.8 to 19.1) hours after onset of septic shock-related hypotension. Median time to initiation of low-dose corticosteroid therapy was significantly shorter in survivors than in non-survivors (6.5 hours versus 10.4 hours; P=0.0135). The mortality rates increased significantly with increasing quintiles of time to initiation of low-dose corticosteroid therapy (P=0.0107 for trend). Other factors associated with 28-day mortality were higher Simplified Acute Physiology Score (SAPS) 3 (P<0.0001) and Sequential Organ Failure Assessment (SOFA) scores (P=0.0007), dose of vasopressor at the time of initiation of low-dose corticosteroid therapy (P<0.0001), need for mechanical ventilation (P=0.0001) and renal replacement therapy (P<0.0001), while the impaired adrenal reserve did not affect 28-day mortality (81% versus 82%; P=0.8679). After adjusting for potential confounding factors, the time to initiation of low-dose corticosteroid therapy was still significantly associated with 28-day mortality (adjusted odds ratio (OR) 1.025, 95% confidence interval (CI) 1.007 to 1.044, P=0.0075). The early therapy group (administered within 6 hours after the onset of septic shock, n=66) had a 37% lower mortality rate than the late therapy group (administered more than 6 hours after the onset of septic shock, n=112) (32% versus 51%, P=0.0132).

Conclusions: Early initiation of low-dose corticosteroid therapy was significantly associated with decreased mortality.

Figures

Figure 1
Figure 1
Trend of 28-day mortality rate according to the time to initiation of low-dose corticosteroid therapy in quintiles (1st quintile, 0 to 3.0 hours; 2nd quintile, 3.1 to 6.3 hours; 3rd quintile, 6.4 to 11.3 hours; 4th quintile 11.4 to 24.5 hours; 5th quintile, ≥ 24.6 h) (P = 0.0107, test for trend).
Figure 2
Figure 2
Kaplan-Meier survival analysis comparing patients treated with low-dose corticosteroid therapy within six hours after development of septic shock and those treated later (solid line represents the early therapy group, who received the therapy within six hours; dotted line represents the late therapy group, who received the therapy after six hours).

Comment in

Similar articles

See all similar articles

Cited by 8 PubMed Central articles

See all "Cited by" articles

References

    1. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303–1310. doi: 10.1097/00003246-200107000-00002. - DOI - PubMed
    1. Angus DC, Pereira CA, Silva E. Epidemiology of severe sepsis around the world. Endocr Metab Immune Disord Drug Targets. 2006;6:207–212. - PubMed
    1. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36:296–327. doi: 10.1097/01.CCM.0000298158.12101.41. - DOI - PubMed
    1. Sweeney DA, Danner RL, Eichacker PQ, Natanson C. Once is not enough: clinical trials in sepsis. Intensive Care Med. 2008;34:1955–1960. doi: 10.1007/s00134-008-1274-6. - DOI - PubMed
    1. Lefering R, Neugebauer EA. Steroid controversy in sepsis and septic shock: a meta-analysis. Crit Care Med. 1995;23:1294–1303. doi: 10.1097/00003246-199507000-00021. - DOI - PubMed

Publication types

Substances

Feedback