Corticosteroids and pediatric septic shock outcomes: A risk stratified analysis

Sarah J. Atkinson; Natalie Z. Cvijanovich; Neal J. Thomas; Geoffrey L. Allen; Nick Anas; Michael T. Bigham; Mark Hall; Robert J. Freishtat; Anita Sen; Keith Meyer; Paul A. Checchia; Thomas P. Shanley; Jeffrey Nowak; Michael Quasney; Scott L. Weiss; Sharon Banschbach; Eileen Beckman; Kelli Howard; Erin Frank; Kelli Harmon; Patrick Lahni; Christopher J. Lindsell; Hector R. Wong

doi:10.1371/journal.pone.0112702

Corticosteroids and pediatric septic shock outcomes: A risk stratified analysis

Sarah J. Atkinson, Natalie Z. Cvijanovich, Neal J. Thomas, Geoffrey L. Allen, Nick Anas, Michael T. Bigham, Mark Hall, Robert J. Freishtat, Anita Sen, Keith Meyer, Paul A. Checchia, Thomas P. Shanley, Jeffrey Nowak, Michael Quasney, Scott L. Weiss, Sharon Banschbach, Eileen Beckman, Kelli Howard, Erin Frank, Kelli HarmonPatrick Lahni, Christopher J. Lindsell, Hector R. Wong

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Abstract

Background: The potential benefits of corticosteroids for septic shock may depend on initial mortality risk.

Objective: We determined associations between corticosteroids and outcomes in children with septic shock who were stratified by initial mortality risk.

Methods: We conducted a retrospective analysis of an ongoing, multi-center pediatric septic shock clinical and biological database. Using a validated biomarker-based stratification tool (PERSEVERE), 496 subjects were stratified into three initial mortality risk strata (low, intermediate, and high). Subjects receiving corticosteroids during the initial 7 days of admission (n = 252) were compared to subjects who did not receive corticosteroids (n = 244). Logistic regression was used to model the effects of corticosteroids on 28-day mortality and complicated course, defined as death within 28 days or persistence of two or more organ failures at 7 days.

Results: Subjects who received corticosteroids had greater organ failure burden, higher illness severity, higher mortality, and a greater requirement for vasoactive medications, compared to subjects who did not receive corticosteroids. PERSEVERE-based mortality risk did not differ between the two groups. For the entire cohort, corticosteroids were associated with increased risk of mortality (OR 2.3, 95% CI 1.3-4.0, p = 0.004) and a complicated course (OR 1.7, 95% CI 1.1-2.5, p = 0.012). Within each PERSEVERE-based stratum, corticosteroid administration was not associated with improved outcomes. Similarly, corticosteroid administration was not associated with improved outcomes among patients with no comorbidities, nor in groups of patients stratified by PRISM.

Conclusions: Risk stratified analysis failed to demonstrate any benefit from corticosteroids in this pediatric septic shock cohort.

Original language	English (US)
Article number	e112702
Journal	PloS one
Volume	9
Issue number	11
DOIs	https://doi.org/10.1371/journal.pone.0112702
State	Published - Nov 11 2014

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Atkinson, S. J., Cvijanovich, N. Z., Thomas, N. J., Allen, G. L., Anas, N., Bigham, M. T., Hall, M., Freishtat, R. J., Sen, A., Meyer, K., Checchia, P. A., Shanley, T. P., Nowak, J., Quasney, M., Weiss, S. L., Banschbach, S., Beckman, E., Howard, K., Frank, E., ... Wong, H. R. (2014). Corticosteroids and pediatric septic shock outcomes: A risk stratified analysis. PloS one, 9(11), Article e112702. https://doi.org/10.1371/journal.pone.0112702

@article{659f1e335c4549d1a3d05f9fde57beaa,

title = "Corticosteroids and pediatric septic shock outcomes: A risk stratified analysis",

abstract = "Background: The potential benefits of corticosteroids for septic shock may depend on initial mortality risk.Objective: We determined associations between corticosteroids and outcomes in children with septic shock who were stratified by initial mortality risk.Methods: We conducted a retrospective analysis of an ongoing, multi-center pediatric septic shock clinical and biological database. Using a validated biomarker-based stratification tool (PERSEVERE), 496 subjects were stratified into three initial mortality risk strata (low, intermediate, and high). Subjects receiving corticosteroids during the initial 7 days of admission (n = 252) were compared to subjects who did not receive corticosteroids (n = 244). Logistic regression was used to model the effects of corticosteroids on 28-day mortality and complicated course, defined as death within 28 days or persistence of two or more organ failures at 7 days.Results: Subjects who received corticosteroids had greater organ failure burden, higher illness severity, higher mortality, and a greater requirement for vasoactive medications, compared to subjects who did not receive corticosteroids. PERSEVERE-based mortality risk did not differ between the two groups. For the entire cohort, corticosteroids were associated with increased risk of mortality (OR 2.3, 95% CI 1.3-4.0, p = 0.004) and a complicated course (OR 1.7, 95% CI 1.1-2.5, p = 0.012). Within each PERSEVERE-based stratum, corticosteroid administration was not associated with improved outcomes. Similarly, corticosteroid administration was not associated with improved outcomes among patients with no comorbidities, nor in groups of patients stratified by PRISM.Conclusions: Risk stratified analysis failed to demonstrate any benefit from corticosteroids in this pediatric septic shock cohort.",

author = "Atkinson, {Sarah J.} and Cvijanovich, {Natalie Z.} and Thomas, {Neal J.} and Allen, {Geoffrey L.} and Nick Anas and Bigham, {Michael T.} and Mark Hall and Freishtat, {Robert J.} and Anita Sen and Keith Meyer and Checchia, {Paul A.} and Shanley, {Thomas P.} and Jeffrey Nowak and Michael Quasney and Weiss, {Scott L.} and Sharon Banschbach and Eileen Beckman and Kelli Howard and Erin Frank and Kelli Harmon and Patrick Lahni and Lindsell, {Christopher J.} and Wong, {Hector R.}",

note = "Publisher Copyright: {\textcopyright} 2014 PLOS ONE.",

year = "2014",

month = nov,

day = "11",

doi = "10.1371/journal.pone.0112702",

language = "English (US)",

volume = "9",

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Atkinson, SJ, Cvijanovich, NZ, Thomas, NJ, Allen, GL, Anas, N, Bigham, MT, Hall, M, Freishtat, RJ, Sen, A, Meyer, K, Checchia, PA, Shanley, TP, Nowak, J, Quasney, M, Weiss, SL, Banschbach, S, Beckman, E, Howard, K, Frank, E, Harmon, K, Lahni, P, Lindsell, CJ & Wong, HR 2014, 'Corticosteroids and pediatric septic shock outcomes: A risk stratified analysis', PloS one, vol. 9, no. 11, e112702. https://doi.org/10.1371/journal.pone.0112702

TY - JOUR

T1 - Corticosteroids and pediatric septic shock outcomes

T2 - A risk stratified analysis

AU - Atkinson, Sarah J.

AU - Cvijanovich, Natalie Z.

AU - Thomas, Neal J.

AU - Allen, Geoffrey L.

AU - Anas, Nick

AU - Bigham, Michael T.

AU - Hall, Mark

AU - Freishtat, Robert J.

AU - Sen, Anita

AU - Meyer, Keith

AU - Checchia, Paul A.

AU - Shanley, Thomas P.

AU - Nowak, Jeffrey

AU - Quasney, Michael

AU - Weiss, Scott L.

AU - Banschbach, Sharon

AU - Beckman, Eileen

AU - Howard, Kelli

AU - Frank, Erin

AU - Harmon, Kelli

AU - Lahni, Patrick

AU - Lindsell, Christopher J.

AU - Wong, Hector R.

PY - 2014/11/11

Y1 - 2014/11/11

N2 - Background: The potential benefits of corticosteroids for septic shock may depend on initial mortality risk.Objective: We determined associations between corticosteroids and outcomes in children with septic shock who were stratified by initial mortality risk.Methods: We conducted a retrospective analysis of an ongoing, multi-center pediatric septic shock clinical and biological database. Using a validated biomarker-based stratification tool (PERSEVERE), 496 subjects were stratified into three initial mortality risk strata (low, intermediate, and high). Subjects receiving corticosteroids during the initial 7 days of admission (n = 252) were compared to subjects who did not receive corticosteroids (n = 244). Logistic regression was used to model the effects of corticosteroids on 28-day mortality and complicated course, defined as death within 28 days or persistence of two or more organ failures at 7 days.Results: Subjects who received corticosteroids had greater organ failure burden, higher illness severity, higher mortality, and a greater requirement for vasoactive medications, compared to subjects who did not receive corticosteroids. PERSEVERE-based mortality risk did not differ between the two groups. For the entire cohort, corticosteroids were associated with increased risk of mortality (OR 2.3, 95% CI 1.3-4.0, p = 0.004) and a complicated course (OR 1.7, 95% CI 1.1-2.5, p = 0.012). Within each PERSEVERE-based stratum, corticosteroid administration was not associated with improved outcomes. Similarly, corticosteroid administration was not associated with improved outcomes among patients with no comorbidities, nor in groups of patients stratified by PRISM.Conclusions: Risk stratified analysis failed to demonstrate any benefit from corticosteroids in this pediatric septic shock cohort.

AB - Background: The potential benefits of corticosteroids for septic shock may depend on initial mortality risk.Objective: We determined associations between corticosteroids and outcomes in children with septic shock who were stratified by initial mortality risk.Methods: We conducted a retrospective analysis of an ongoing, multi-center pediatric septic shock clinical and biological database. Using a validated biomarker-based stratification tool (PERSEVERE), 496 subjects were stratified into three initial mortality risk strata (low, intermediate, and high). Subjects receiving corticosteroids during the initial 7 days of admission (n = 252) were compared to subjects who did not receive corticosteroids (n = 244). Logistic regression was used to model the effects of corticosteroids on 28-day mortality and complicated course, defined as death within 28 days or persistence of two or more organ failures at 7 days.Results: Subjects who received corticosteroids had greater organ failure burden, higher illness severity, higher mortality, and a greater requirement for vasoactive medications, compared to subjects who did not receive corticosteroids. PERSEVERE-based mortality risk did not differ between the two groups. For the entire cohort, corticosteroids were associated with increased risk of mortality (OR 2.3, 95% CI 1.3-4.0, p = 0.004) and a complicated course (OR 1.7, 95% CI 1.1-2.5, p = 0.012). Within each PERSEVERE-based stratum, corticosteroid administration was not associated with improved outcomes. Similarly, corticosteroid administration was not associated with improved outcomes among patients with no comorbidities, nor in groups of patients stratified by PRISM.Conclusions: Risk stratified analysis failed to demonstrate any benefit from corticosteroids in this pediatric septic shock cohort.

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U2 - 10.1371/journal.pone.0112702

DO - 10.1371/journal.pone.0112702

M3 - Article

C2 - 25386653

AN - SCOPUS:84956619811

SN - 1932-6203

VL - 9

JO - PloS one

JF - PloS one

IS - 11

M1 - e112702

ER -

Corticosteroids and pediatric septic shock outcomes: A risk stratified analysis

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