Document Detail

Low-dose steroid therapy does not affect hemodynamic response in septic shock patients.
MedLine Citation:
PMID:  18086404     Owner:  NLM     Status:  MEDLINE    
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.
Joan M Raurich; Juan A Llompart-Pou; Jordi Ibáñez; Guillem Frontera; Olatz Pérez; Laura García; José I Ayestarán
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of critical care     Volume:  22     ISSN:  0883-9441     ISO Abbreviation:  J Crit Care     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2007-12-18     Completed Date:  2008-02-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8610642     Medline TA:  J Crit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  324-9     Citation Subset:  IM    
Servicio de Medicina Intensiva, Hospital Universitario Son Dureta, 07014 Palma de Mallorca, Spain.
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MeSH Terms
Anti-Inflammatory Agents / administration & dosage,  pharmacology*
Fludrocortisone / administration & dosage,  pharmacology
Hemodynamics / drug effects*
Hydrocortisone / administration & dosage,  pharmacology*
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Retrospective Studies
Shock, Septic / drug therapy*,  physiopathology
Survival Analysis
Reg. No./Substance:
0/Anti-Inflammatory Agents; 127-31-1/Fludrocortisone; 50-23-7/Hydrocortisone

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