Adjunctive Corticosteroid Treatment in Septic Shock

Cohen, Jérémy; Venkatesh, Balasubramanian

doi:10.1097/aln.0000000000002604

Cited by 6 publications

(1 citation statement)

References 44 publications

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“…However, these benefits did not contribute to a significant improvement in short-term mortality. The outcomes of previous studies may have been influenced by internal factors such as the immunity and inflammatory status of septic shock patients (14). Since neutrophils are essential for clearance of pathogenic organisms, studies have indicated that monocyte and neutrophil function could be inhibited with endotoxin stimulation (15).…”

Section: Introductionmentioning

confidence: 99%

Association between corticosteroid use and 28-day mortality in septic shock patients with gram-negative bacterial infection: a retrospective study

Dong,

Heng,

Zhang

et al. 2023

Front. Med.

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PurposeAlthough corticosteroids are recommended in the 2021 Surviving Sepsis Campaign (SSC) guidelines, evidence with respect to their effects on short-term mortality remains conflicting. We conducted this study to identify whether corticosteroids alter 28-day mortality in septic shock patients with gram-negative bacterial infection.Materials and methodsA total of 621 patients with septic shock and gram-negative bacterial culture results were identified from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Propensity score matching (PSM) was performed, and Kaplan–Meier survival curve analyses with log-rank tests were used to determine the relationship between corticosteroid use and the risk of 28-day mortality. Subgroup analyses were conducted to assess whether the conclusions were stable and reliable.ResultsCorticosteroid administration was associated with increased 28-day mortality in septic shock patients with gram-negative bacterial infection (log-rank test P = 0.028). The incidence of Stage 2 or 3 AKI and the rate of hospital mortality were higher among patients who received corticosteroids. The incidence of Stage 2 or 3 AKI in the early period significantly mediated the relationship between corticosteroid use and 28-day mortality [P =0.046 for the average causal mediation effect (ACME)]. Interaction tests indicated that the effect of corticosteroid use was maintained in patients with a neutrophil-to-lymphocyte ratio (NLR) of <20 (P-value for interaction = 0.027).ConclusionSystemic corticosteroid use could be harmful in septic shock patients with gram-negative bacterial infection, especially in patients with relatively low NLR.

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Section: Introductionmentioning

confidence: 99%