Early Administration of Hydrocortisone Replacement After the Advent of Septic Shock

Katsenos, Chrysostomos; Antonopoulou, Anastasia N.; Apostolidou, Efterpi; Ioakeimidou, Aikaterini; Kalpakou, Georgia; Papanikolaou, Metaxia; Pistiki, Aikaterini; Mpalla, Margarita; Paraschos, Michael; Patrani, Maria; Pratikaki, Maria; Retsas, Theodoros; Savva, Athina; Vassiliagkou, Spyridoula D.; Lekkou, Alexandra; Dimopoulou, Ioanna; Routsi, Christina; Mandragos, Konstantinos

doi:10.1097/ccm.0000000000000318

Cited by 61 publications

(55 citation statements)

References 20 publications

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“…Of note, hydrocortisone had no effect on IL-10 level when it has been administered more than 6 hours before the endotoxin. These data were confirmed in a recent issue of the journal (37). The authors demonstrated that early or late initiation of hydrocortisone treatment induces different patterns of TNF-α production and impact the mortality rate.…”

Section: Discussionsupporting

confidence: 52%

Hydrocortisone Prevents Immunosuppression by Interleukin-10+ Natural Killer Cells After Trauma-Hemorrhage

Roquilly

Broquet

Jacqueline

et al. 2014

Critical Care Medicine

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Section: Discussionsupporting

confidence: 52%

Hydrocortisone Prevents Immunosuppression by Interleukin-10+ Natural Killer Cells After Trauma-Hemorrhage

Roquilly

Broquet

Jacqueline

et al. 2014

Critical Care Medicine

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“…This finding suggests that we should apply corticosteroid once adrenal insufficiency is identified, not wait until irreversible hypotension has developed. In support of this notion, a recent study showed that early corticosteroid therapy improves survival in septic shock patients (12,13); 3) this study also supports the use of corticosteroid cocktail. Sepsis induces a group of corticosteroids which may work together.…”

Section: Implications For Corticosteroid Therapymentioning

confidence: 60%

“…Numerous efforts have been made but the results are inconclusive (8)(9)(10)(11). Nevertheless, the debate is still ongoing and recent studies show that early corticosteroid therapy may improve survival in septic shock patients (12,13) or in sicker septic shock patients (14,15).…”

mentioning

confidence: 97%

Corticosteroid Therapy Benefits Septic Mice With Adrenal Insufficiency But Harms Septic Mice Without Adrenal Insufficiency*

Guo

Zheng

et al. 2015

Critical Care Medicine

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This study demonstrates that corticosteroid treatment benefits mice with adrenal insufficiency but harms mice without adrenal insufficiency. This study also reveals that inducible corticosteroid has both immunosuppressive and immunopermissive properties, suppressing interleukin-6 production, promoting phagocytosis of immune effector cells, but not inducing peripheral lymphocyte apoptosis. These findings support our hypothesis that corticosteroid is an effective therapy for a subgroup of septic patients with adrenal insufficiency but harms septic patients without adrenal insufficiency and encourage further efforts to test this hypothesis in clinic.

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“…This may be important because a recent, small study suggests that administration of corticosteroids within nine hours of vasopressor initiation leads to improved outcomes [28]. Conversely, a much larger study by Casserly et al showed that adjunctive corticosteroids are associated with increased adjusted hospital mortality even when prescribed within eight hours of vasopressor initiation [3].…”

Section: Discussionmentioning

confidence: 99%

Corticosteroids and Pediatric Septic Shock Outcomes: A Risk Stratified Analysis

et al. 2014

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BackgroundThe potential benefits of corticosteroids for septic shock may depend on initial mortality risk.ObjectiveWe determined associations between corticosteroids and outcomes in children with septic shock who were stratified by initial mortality risk.MethodsWe conducted a retrospective analysis of an ongoing, multi-center pediatric septic shock clinical and biological database. Using a validated biomarker-based stratification tool (PERSEVERE), 496 subjects were stratified into three initial mortality risk strata (low, intermediate, and high). Subjects receiving corticosteroids during the initial 7 days of admission (n = 252) were compared to subjects who did not receive corticosteroids (n = 244). Logistic regression was used to model the effects of corticosteroids on 28-day mortality and complicated course, defined as death within 28 days or persistence of two or more organ failures at 7 days.ResultsSubjects who received corticosteroids had greater organ failure burden, higher illness severity, higher mortality, and a greater requirement for vasoactive medications, compared to subjects who did not receive corticosteroids. PERSEVERE-based mortality risk did not differ between the two groups. For the entire cohort, corticosteroids were associated with increased risk of mortality (OR 2.3, 95% CI 1.3–4.0, p = 0.004) and a complicated course (OR 1.7, 95% CI 1.1–2.5, p = 0.012). Within each PERSEVERE-based stratum, corticosteroid administration was not associated with improved outcomes. Similarly, corticosteroid administration was not associated with improved outcomes among patients with no comorbidities, nor in groups of patients stratified by PRISM.ConclusionsRisk stratified analysis failed to demonstrate any benefit from corticosteroids in this pediatric septic shock cohort.

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Early Administration of Hydrocortisone Replacement After the Advent of Septic Shock

Abstract: In patients receiving hydrocortisone for septic shock, early initiation of treatment was associated with improved survival. This treatment was also associated with attenuated stimulation of tumor necrosis factor-α.

Cited by 61 publications

References 20 publications

Hydrocortisone Prevents Immunosuppression by Interleukin-10+ Natural Killer Cells After Trauma-Hemorrhage

Hydrocortisone Prevents Immunosuppression by Interleukin-10+ Natural Killer Cells After Trauma-Hemorrhage

Corticosteroid Therapy Benefits Septic Mice With Adrenal Insufficiency But Harms Septic Mice Without Adrenal Insufficiency*

Corticosteroids and Pediatric Septic Shock Outcomes: A Risk Stratified Analysis

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