Low-Dose Corticosteroid Treatment in Septic Shock

Funk, Duane J.; Doucette, Steven; Pisipati, Amarnath; Dodek, Peter; Marshall, John C.; Kumar, Anand

doi:10.1097/ccm.0000000000000518

Cited by 29 publications

(15 citation statements)

References 32 publications

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“…However, this was not observed in our multivariate analysis following adjustment by severity, among other predictive outcome measures in the final model. [23][24][25][26][27] Regarding the association of vasoactive drugs and fluid administration in the first hours with mortality, it is worth noting that this study was not initially designed to identify potential predictive outcome measures. 1 Data analyzed based on the total number of events of severe sepsis (total = 335).…”

Section: Discussionmentioning

confidence: 99%

Epidemiological study of pediatric severe sepsis in Argentina

Jabornisky¹,

Saenz²,

Capocasa³

et al. 2019

Arch Argent Pediat

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Introduction. Severe sepsis (SS) is one of the leading causes of pediatric mortality in Argentina. The objective was to describe the epidemiological characteristics and to analyze risk factors associated with mortality from SS among patients hospitalized in pediatric intensive care units (PICU) in Argentina. Population and Methods. Observational, prospective cohort study among patients with SS hospitalized in PICUs in Argentina from 8/1/2008 to 9/30/2008. Results. Two thousand five hundred and fifty nine patients were admitted at 59 PICUs. A total of 315 patients (335 events) were included. Patients' median age was 8 months (1-182). The frequency was 13.8 %, and 28-day mortality was 31.6 %. Patients with a higher mortality were those who were coming from rural areas, had comorbidities at the time of admission or a history of cancer, had shock or acute respiratory distress syndrome (ARDS), were administered low-dose corticosteroids or vasoactive drugs or more than 60 ml/kg of fluid in the first hour and in the first 6 hours, and had severe malnutrition. Following adjustment by severity using a multivariate logistic regression model, only coming from a rural area, having shock or ARDS remained associated with 28-day mortality. Forty per cent of patients received antibiotics 60 minutes after diagnosis. Conclusions. SS is an event with a high frequency and mortality in Argentina. In the severity adjusted multivariate analysis, only coming from a rural area, having ARDS and/or shock were associated with higher mortality.

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Section: Discussionmentioning

confidence: 99%

Epidemiological study of pediatric severe sepsis in Argentina

Jabornisky¹,

Saenz²,

Capocasa³

et al. 2019

Arch Argent Pediat

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“…Acknowledgement: Patients in this cohort have been previously published in larger septic shock and cirrhotic population‐based studies published by the CATTS group . Other CATTS study wide critically ill septic shock studies that may have included cirrhotic patients with SBP include …”

Section: Discussionmentioning

confidence: 99%

Appropriate and timely antimicrobial therapy in cirrhotic patients with spontaneous bacterial peritonitis‐associated septic shock: a retrospective cohort study

Karvellas

Abraldes

Arabi

et al. 2015

Aliment Pharmacol Ther

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Summary Background Spontaneous bacterial peritonitis (SBP)‐associated septic shock carries significant mortality in cirrhosis. Aim To determine whether practice‐related aspects of antimicrobial therapy contribute to high mortality. Methods Retrospective cohort study of all (n = 126) cirrhotics with spontaneous bacterial peritonitis (neutrophil count >250 or positive ascitic culture)‐associated septic shock (1996–2011) from an international, multicenter database. Appropriate antimicrobial therapy implied either in vitro activity against a subsequently isolated pathogen (culture positive) or empiric management consistent with broadly accepted norms (culture negative). Results Overall hospital mortality was 81.8%. Comparing survivors (n = 23) with non‐survivors (n = 103), survivors had lower Acute Physiology and Chronic Health Evaluation (APACHEII) (mean ± s.d.; 22 ± 7 vs. 32 ± 8) and model for end‐stage liver disease (MELD) (24 ± 9 vs. 34 ± 11) scores and serum lactate on admission (4.9 ± 3.1 vs. 8.9 ± 5.3), P < 0.001 for all. Survivors were less likely to receive inappropriate initial antimicrobial therapy (0% vs. 25%, P = 0.013) and received appropriate antimicrobial therapy earlier [median 1.8 (1.1–5.2) vs. 9.5 (3.9–14.3) h, P < 0.001]. After adjusting for covariates, APACHEII [OR, odds ratio 1.45 (1.04–2.02) per 1 unit increment, P = 0.03], lactate [OR 2.34 (1.04–5.29) per unit increment, P = 0.04] and time delay to appropriate antimicrobials [OR 1.86 (1.10–3.14) per hour increment, P = 0.02] were significantly associated with increased mortality. Conclusions Cirrhotic patients with septic shock secondary to spontaneous bacterial peritonitis have high mortality (>80%). Each hour of delay in appropriate antimicrobial therapy was associated with a 1.86 times increased hospital mortality. Admission APACHEII and serum lactate also significantly impacted hospital mortality. Earlier initiation of appropriate antimicrobial therapy could substantially improve outcome.

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“…Regarding sepsis and septic shock, despite more than 30 years' research, few firm conclusions have been reached. If a faster reversal of shock is consistently found with the administration of low-dose corticosteroids, impact on mortality is still a matter of debate [8,9]. Results regarding CAP share the same uncertainties.…”

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confidence: 82%

Low-dose corticosteroids during severe community-acquired pneumonia: end of the story

Ricard

Messika

2015

Eur Respir J

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@ERSpublicationsIn cases of community-acquired pneumonia, corticosteroids should only be given if septic shock is also present http://ow.ly/FUCHN Community-acquired pneumonia (CAP) remains a leading cause of death worldwide despite improvement in patient management. Early recognition of lung infection and prompt initiation of adequate antibiotherapy are crucial elements to ensuring favourable outcomes [1][2][3]. Nonetheless, in a number of cases, death occurs despite both these targets being met. In these patients, possible excessive inflammatory responses, as in sepsis and septic shock, are believed to contribute to unfavourable outcome. Animal models have elegantly shown that part of the inflammatory response, initially destined to combat the pathogens invading the lungs (such as neutrophil products) may induce tissue damage even in the absence of any bacterial challenge [4]. They have also provided evidence that inhibiting inflammatory signalling lessens lung injury in murine models of Escherichia coli [5,6] or Pseudomonas aeruginosa [7] pneumonia. These results and many others have prompted clinicians to investigate the potential benefit of administering corticosteroids to counterbalance an intense inflammatory process in order to improve outcome. This search has been a long and winding road which many researchers have taken with varying success.As of 2014, what certainties do we have on the benefits of corticosteroids in the setting of acute respiratory failure?The ineffectiveness and potential harm of high doses of corticosteroids in the early stage of ARDS might be the only definite conclusion on which many, if not all, clinicians would agree. Regarding sepsis and septic shock, despite more than 30 years' research, few firm conclusions have been reached. If a faster reversal of shock is consistently found with the administration of low-dose corticosteroids, impact on mortality is still a matter of debate [8,9]. Results regarding CAP share the same uncertainties. This is perhaps not that surprising since pneumonia is, by far, the leading aetiology of sepsis and septic shock. These uncertainties may reflect the difficulty in differentiating severe CAP from sepsis and septic shock, and providing answers to the following questions: what is severe CAP and when is severe CAP no longer severe CAP but septic shock of pulmonary origin? Does this distinction matter? In other words, is there a specific effect of corticosteroids on CAP, distinct from its effect on septic shock from a pulmonary origin?In this issue of the European Respiratory Journal, results from TAGAMI et al. [10] shed new light on the potential benefit of corticosteroids and offer an interesting perspective on the current debate. They analysed the data of 6925 patients who received mechanical ventilation for severe CAP in 893 hospitals in Japan between July 2010 and March 2013. Main outcome was 28-day mortality. Authors cogently analysed this large national cohort with respect to catecholamine and corticosteroid uses. Over a third of patients recei...

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Low-Dose Corticosteroid Treatment in Septic Shock

Cited by 29 publications

References 32 publications

Epidemiological study of pediatric severe sepsis in Argentina

Epidemiological study of pediatric severe sepsis in Argentina

Appropriate and timely antimicrobial therapy in cirrhotic patients with spontaneous bacterial peritonitis‐associated septic shock: a retrospective cohort study

Low-dose corticosteroids during severe community-acquired pneumonia: end of the story

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