Steroid Combo Does Not Increase Shock Free Days in Septic Shock Patients

The beneficial effects of systematic corticosteroid treatment in adult patients with septic shock have been controversial. Although corticosteroids have been shown to improve blood pressure, there are conflicting results on survival benefits in recent large randomized controlled trials (RCTs) and systematic reviews, resulting in the lack of definitive recommendations in several clinical guidelines. Therefore, Dr John, Kayla and her team conducted a study to assess the impact of the addition of fludrocortisone to hydrocortisone on shock-free days in patients with septic shock.

In a single-centre, retrospective propensity score weighted cohort study, the researchers included 228 patients with septic shock who received ≥200 mg/day hydrocortisone for at least 24 hours ± fludrocortisone initiated within 72 hours of vasopressors. They performed propensity score matching utilizing inverse probability weighting and trimming. The major outcome assessed was the number of shock-free days by day 14. They further assessed the duration of shock, change in Sequential Organ Failure Assessment (SOFA) score, maximum daily vasopressor dose in norepinephrine equivalents on days 1-7, hospital and ICU length of stay, and in-hospital mortality.

Key findings of the study:

• Among 228 patients, 212 patients were retained after propensity score matching with 111 in the hydrocortisone group and 101 in the hydrocortisone plus fludrocortisone group.
• After score weighting, the researchers found that there were no significant differences in baseline characteristics between groups.
• They observed no statistical difference between treatment groups regarding 14-day shock-free days (6.3 vs 6.1 days) or in-hospital mortality (46.7 vs 52.2%).
• They also found no significant differences regarding the secondary outcomes of ICU and hospital length of stay, duration of shock, or change in SOFA score.
• Regarding maximum daily vasopressor doses, they noted that the days 1-6 were not significantly different, however, day 7 did have a significant difference between the two groups (0.00 vs 0.1 NEeq).

The authors concluded, "The addition of fludrocortisone to hydrocortisone in septic shock did not increase the number of shock-free days. Further studies are needed to assess the clinical utility of these findings."

For further information:

DOI:10.1097/01.com.0000806484.52234.f6

Keywords:

Fludrocortisone, hydrocortisone, Corticosteroids, shock-free days, septic shock, SOFA score,in-hospital mortality, hospital stay, Vasopressor dose, Critical Care Medicine.