摘要
Background:Current guidelines recommend the addition of hydrocortisone 200 mg/day for the treatment of septic shock unresponsive to fluids and vasopressors.However,the benefits of adding a 100 mg bolus to this regimen remain unclear.The study assessed the efficacy of the administration of hydrocortisone 200 mg/day with or without a 100 mg bolus in refractory septic shock.Methods:This retrospective cohort study included adult patients with refractory septic shock treated at a tertiary care center between 2019 and 2023.Patients were divided into bolus group(receiving a 100 mg hydrocortisone bolus followed by a 200 mg/day continuous infusion)and non-bolus group(receiving a continuous infusion of 200 mg/day without the addition of a bolus)based on physician decision.The primary outcomes were the duration of vasopressor and shock reversal.Secondary outcomes included 28-day mortality and length of hospital stay.Comparisons between groups were performed using chi-squared tests,t-tests,and Kaplan-Meier survival analysis.Results:A total of 184 patients were included,149 patients in the bolus group and 35 patients in the non-bolus group.The median vasopressor duration was 1(interquartile range[IQR]:1-2)days in both groups(P=0.967).Shock reversal occurred in 79.9%of the bolus group and 82.9%of the non-bolus group(OR=0.82,95%CI:0.30 to 2.23,P=0.688).Secondary outcomes in the bolus group and non-bolus group,including 28-day mortality(30.2%vs.22.9%,OR=1.46,95%CI:0.62 to 3.43,P=0.745)and hospital length of stay(9[IQR:6-17]days vs.11[IQR:5-15]days,P=0.875),did not show any significant differences.Kaplan-Meier survival analysis showed no difference in 28-day survival between groups(HR=1.29,95%CI:0.73 to 2.30,P=0.373).Conclusion:The addition of a 100 mg bolus to a 200 mg/day hydrocortisone regimen may not impact clinical outcomes in refractory septic shock.
基金
This research was supported by the Research Administration Division,Faculty of Medicine,Chiang Mai University(grant number 135-2567).
