Continuous hydrocortisone infusion does not reduce mortality rates in patients with septic shock on mechanical ventilation systems, according to a study published in the New England Journal of Medicine.
Balasubramanian Venkatesh, MD, from the George Institute for Global Health at the University of New South Wales and associates, assessed the impact of hydrocortisone on mortality in patients with sepsis.
The investigators randomly grouped 3800 septic shock patients on mechanical ventilators to be administered either 200 mg of hydrocortisone per day or a placebo. The randomized treatment lasted for either 7 days, until death, or until patients were discharged from the intensive care unit (ICU), whichever was first.
The primary outcome was any cause mortality at 90 days. Of the initial 3800 patients, 3658 patient results were obtained for the primary outcome (1832 of which were in the hydrocortisone group and 1826 in the control group).
By day 90,511 patients taking hydrocortisone (27.9%) and 526 (28.8%) taking the placebo died (odds ratio, 0.95). The investigators noticed a quicker shock resolve (hazard ratio, 1.32), decreased length of time on initial mechanical ventilation (HR, 1.13), and fewer blood transfusions in patients receiving hydrocortisone (OR, 0.82) compared with patients taking the placebo.
Rates of mortality at 28 days, shock relapse, and renal-replacement therapy were not statistically significant between the two treatment groups. Results were also insignificant for the number of days that patients were alive and out of the ICU or hospital, mechanical ventilation recurrence, and occurrence of new-onset bacterial or fungal infections between the two patient groups.
“Although we did not observe a significant difference between the hydrocortisone group and the placebo group with regard to 90-day mortality, some secondary outcomes were better in the group that received the active treatment,” reported the authors. “A detailed cost–benefit assessment of these results was not done, but such an analysis may inform clinicians about the overall cost-effectiveness of hydrocortisone in patients with septic shock.”
Venkatesh B, Finder S, Cohen J, et al. Adjunctive glucocorticoid therapy in patients with septic shock. N Engl J Med. 2018 Jan 19. doi: 10.1056/NEJMoa1705835