Brandon Boelts, PharmD
Baylor Scott & White Health
Dallas, Texas
Disclosure information not submitted.
Klayton Ryman, PharmD, BCCCP
Baylor University Medical Center - Dallas
Dallas, Texas
Disclosure information not submitted.
Vivek Kataria, PharmD, BCCCP
Clinical Pharmacist - MICU
Baylor University Medical Center, United States
Disclosure information not submitted.
Xuan Wang, PhD
Statistician
Baylor University Medical Center, United States
Disclosure information not submitted.
Adam Hayek, DO
Pulmonary and Critical Care Medicine Physician
Baylor University Medical Center, United States
Disclosure information not submitted.
Ariel Modrykamien, MD
Pulmonary and Critical Care Medicine Physician
Baylor University Medical Center, United States
Disclosure information not submitted.
Title: Timing of Stress Dose Steroids in Septic Shock
Introduction: Septic shock is associated with high mortality, and the timing of therapies following crystalloids and vasopressors is not well established.
Objective: This retrospective study included adult patients admitted to the intensive care unit (ICU) at a single center. We compared outcomes in patients who received stress dose steroids within 12 hours from vasopressor initiation to those who received corticosteroids between 12 and 24 hours from vasopressor initiation at 14 days.
Methods: Cox-proportional hazards models and log-rank tests were used for survival analysis, and a hurdle model was utilized to account for patient covariates.
Results: Survival within 14 days was improved with early administration [HR=0.50; 95% CI: 0.30-0.84), p < 0.01]. Among the patients analyzed in the non-adjusted multivariate analysis, increased number of vasopressors (3 or more) was an independent predictor of fewer vasopressor free days. In the multivariate analysis modelling probability of zero-day vs non-zero vasopressor free days, increased number of vasopressors (3 or more) was an independent predictor negatively associated with vasopressor free days (log odds ratio -2.18, p = 0.0059). In the adjusted multivariate analysis modeling positive counts of vasopressor days, shorter time to steroid initiation was an independent predictor of increased vasopressor free days (log relative risk 0.1673, p < 0.02), and increased number of vasopressors 2 and 3+ remained independent predictors of reduced vasopressor free days (log relative risk -0.2095 and -0.5007, p = 0.0015 and 0.036, respectively).
Conclusion: These results highlight possible benefit of early initiation of stress dose steroids following initial crystalloid and vasopressor therapy in patients with septic shock.