Patrick Tednes, PharmD, BCCCP
Assistant Professor of Clinical Sciences
n/a
Schaumburg, Illinois
Disclosure information not submitted.
Kevin Chang, PharmD, BCCCP
Surgical/Trauma Intensive Care Unit Clinical Pharmacist
Loyola University Medical Center, United States
Disclosure information not submitted.
Whitney Chaney, PharmD, BCPS, BCCCP
Surgical/Trauma Intensive Care Unit Clinical Pharmacist
Loyola University Medical Center, United States
Disclosure information not submitted.
Title: Impact of time to initiation of stress dose steroids on vasopressor therapy duration in septic shock
Introduction:
Septic shock is a subset of sepsis in which patients have profound circulatory, cellular, and metabolic abnormalities that result in high risk for mortality. The use of stress-dose steroids (SDS) is controversial in septic shock, but remains a common intervention in this patient population. Guidelines suggest against intravenous hydrocortisone to treat septic shock if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability. Trials have shown varying levels of benefit of SDS for outcomes including time to reversal of shock, vasopressor-free days, and intensive care unit (ICU) length of stay (LOS). This study investigates if early initiation of SDS has added benefit to decreasing duration of vasopressor therapy.
Methods:
This retrospective, observational, cohort study identified patients who received SDS therapy while in septic shock between Jan 2015 and Jun 2020. Patients were dichotomized to early (< 24 hours) or late ( >24 hours) initiation of SDS. The primary endpoint was duration of vasopressor therapy. Secondary endpoints included duration of SDS therapy, new-onset renal failure, ICU and hospital LOS, time to reversal of shock, and mortality. Safety endpoints included frequency of hyperglycemia, delirium, and gastrointestinal bleeds. Statistics of baseline characteristics and outcomes data were completed via SPSS software.
Results:
Of 99 patients included in this study, 57 patients were dichotomized to early SDS and 42 were dichotomized to late SDS. Patients had similar baseline characteristics and acuity of illness. Those who received early SDS required a median of 2.2 days (IQR 1.5 to 4.3 days) of vasopressor therapy compared to 6.6 days (IQR 4.1 to 9.2 days) for those who received late SDS (p< 0.01). A Kaplan-Meier survival curve also demonstrated a decrease in time-to-death for patients who received SDS within 24 hours (p=0.03).
Conclusions:
This study found that patients in septic shock who were started on SDS within 24 hours had a decrease in duration of vasopressor therapy, a decrease in duration of norepinephrine and vasopressin, a decreased utilization of vasopressin, a faster time to shock reversal, a shorter intensive care unit length of stay, and an improved 30-day mortality. No statistical difference was seen in the safety profile between groups.