Low-dose corticosteroid treatment in septic shock: A propensity-matching study

Duane Funk, Steven Doucette, Amarnath Pisipati, Peter Dodek, John C. Marshall, Anand Kumar, Yaseen Arabi, Phillip Dellinger, Sandra Dial, Paul Ellis, Daniel Feinstein, Dave Gurka, Jose Guzman, Sean Keenan, Andreas Kramer, Aseem Kumar, Stephen Lapinsky, Denny Laporta, Kevin Laupland, Bruce LightDennis Maki, Greg Martinka, Ziad Memish, Yazdan Mirzanejad, Joseph E. Parrillo, Gourang Patel, Charles Penner, Dan Roberts, John Ronald, Dave Simon, Sat Sharma, Nehad Al Shirawi, Gordon Wood, Kenneth E. Wood, Sergio Zanotti

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Abstract

Objective: Given conflicting data and current guidelines, low-dose corticosteroids are often used in the treatment of septic shock. To evaluate the therapeutic benefit of early low-dose corticosteroid in patients with septic shock. Design: Retrospective, multicenter, propensity-matched cohort study. Setting: ICUs of 28 academic and community hospitals in three countries between 1996 and 2007. Subjects: Six thousand six hundred sixty-three eligible patients with septic shock of whom 1,838 received IV low-dose corticosteroid treatment within 48 hours of the diagnosis of septic shock and were matched to a comparable group who did not receive low-dose corticosteroid. Measurements and Main Results: The primary outcome was 30-day mortality. Mortality analyses were stratified by severity of illness (Acute Physiology and Chronic Health Evaluation II quartile). Using a Cox proportional hazards model, corticosteroid therapy was associated with similar 30-day mortality when compared with the matched control cohort (652/1,838 [35.5%] vs 641/1,838 [34.9%]; hazard ratio, 0.98; 95% CI, 0.88-1.10; p = 0.77). In the subgroup of patients with the Acute Physiology and Chronic Health Evaluation II score quartile more than or equal to 30, low-dose corticosteroid was associated with lower mortality (232/461 [50.6%] vs 251/450 [55.8%]; hazard ratio, 0.81; 95% CI, 0.68-0.97; p = 0.02). In logistic regression models, corticosteroid therapy was not associated with reductions in ICU (556/1,838 [30.3%] vs 558/1,838 [30.4%]; odds ratio, 0.99; 95% CI, 0.86-1.15; p = 0.94) or hospital mortality (797/1,838 [43.4%] vs 773/1,838 [42.1%]; odds ratio, 1.05; 95% CI, 0.93-1.20; p = 0.42). Similarly, there were no significant differences in ventilator-(median and interquartile range, 13 [0-25] vs 15 [0-25]; p = 0.8) and pressor/inotrope-free days (median and interquartile range, 25 [3-27] vs 24 [2-28]; p = 0.63) up to 30 days between groups. Conclusion: Early administration of low-dose corticosteroid is not associated with decreased mortality when it is administered to unselected patients with septic shock. A beneficial effect of low-dose corticosteroid on mortality may exist in patients with the highest severity of illness. Future trials of low-dose corticosteroid in septic shock should consider restricting the study population to this cohort.

Original languageEnglish (US)
Pages (from-to)2333-2341
Number of pages9
JournalCritical care medicine
Volume42
Issue number11
DOIs
StatePublished - 2014

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

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