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Comparison of Early Versus Late Initiation of Hydrocortisone in Patients With Septic Shock in the ICU Setting

Comparison of Early Versus Late Initiation of Hydrocortisone in Patients With Septic Shock in the... Background:Multiple publications demonstrate an association between time to initiation of corticosteroids and outcomes such as mortality and reversal of shock. However, the optimal time to initiate hydrocortisone remains unknown.Objective:To evaluate the impact of early versus late initiation of hydrocortisone in septic shock patients.Methods:A retrospective, multicentered, observational study was conducted. Adults admitted from July 1, 2014, to August 31, 2019, diagnosed with septic shock receiving vasopressors and low-dose hydrocortisone were evaluated. Participants were divided into the “early” group if hydrocortisone was initiated within 12 hours or “late” group if initiated after 12 hours of vasopressor initiation. The primary outcome was time to vasopressor discontinuation. Secondary outcomes included in-hospital mortality, intensive care unit (ICU) and hospital length of stay (LOS), vasopressor utilization, fluids administered, and need for renal replacement therapy.Results:A total of 198 patients were identified for inclusion in this propensity score–weighted cohort: 99 in the early group and 99 in the late group. Early initiation was associated with shorter time to vasopressor discontinuation compared with late initiation (40.7 vs 60.6 hours; P = 0.0002). There was also a reduction in ICU LOS (3.6 vs 5.1 days; P = 0.0147) and hospital LOS (8.9 vs 10.9 days; P = 0.0220) seen in the early group. There was no difference in mortality between groups.Conclusion and Relevance:In this propensity-matched cohort, administration of hydrocortisone within 12 hours from the onset of septic shock was associated with improved time to vasopressor discontinuation and reduced ICU and hospital LOS. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Annals of Pharmacotherapy SAGE

Comparison of Early Versus Late Initiation of Hydrocortisone in Patients With Septic Shock in the ICU Setting

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References (18)

Publisher
SAGE
Copyright
© The Author(s) 2021
ISSN
1060-0280
eISSN
1542-6270
DOI
10.1177/10600280211021103
Publisher site
See Article on Publisher Site

Abstract

Background:Multiple publications demonstrate an association between time to initiation of corticosteroids and outcomes such as mortality and reversal of shock. However, the optimal time to initiate hydrocortisone remains unknown.Objective:To evaluate the impact of early versus late initiation of hydrocortisone in septic shock patients.Methods:A retrospective, multicentered, observational study was conducted. Adults admitted from July 1, 2014, to August 31, 2019, diagnosed with septic shock receiving vasopressors and low-dose hydrocortisone were evaluated. Participants were divided into the “early” group if hydrocortisone was initiated within 12 hours or “late” group if initiated after 12 hours of vasopressor initiation. The primary outcome was time to vasopressor discontinuation. Secondary outcomes included in-hospital mortality, intensive care unit (ICU) and hospital length of stay (LOS), vasopressor utilization, fluids administered, and need for renal replacement therapy.Results:A total of 198 patients were identified for inclusion in this propensity score–weighted cohort: 99 in the early group and 99 in the late group. Early initiation was associated with shorter time to vasopressor discontinuation compared with late initiation (40.7 vs 60.6 hours; P = 0.0002). There was also a reduction in ICU LOS (3.6 vs 5.1 days; P = 0.0147) and hospital LOS (8.9 vs 10.9 days; P = 0.0220) seen in the early group. There was no difference in mortality between groups.Conclusion and Relevance:In this propensity-matched cohort, administration of hydrocortisone within 12 hours from the onset of septic shock was associated with improved time to vasopressor discontinuation and reduced ICU and hospital LOS.

Journal

Annals of Pharmacotherapy – SAGE

Published: Mar 1, 2022

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