Publication:
Clinical outcomes of minimized hydrocortisone dosage of 100mg/day on lower occurrence of hyperglycemia in septic shock patients

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Issued Date

2018

Resource Type

Article

File Type

application/pdf

ISSN

10732322

DOI

10.1097/SHK.0000000000001061

Other identifier(s)

2-s2.0-85051031361

Rights Holder(s)

Scopus

Bibliographic Citation

Shock. Vol 50, No.3 (2018), p.280-285

Suggested Citation

Ngaosuwan K., Ounchokdee K., Chalermchai T. Clinical outcomes of minimized hydrocortisone dosage of 100mg/day on lower occurrence of hyperglycemia in septic shock patients. Shock. Vol 50, No.3 (2018), p.280-285. doi:10.1097/SHK.0000000000001061 Retrieved from: https://hdl.handle.net/20.500.14740/3816

Title

Clinical outcomes of minimized hydrocortisone dosage of 100mg/day on lower occurrence of hyperglycemia in septic shock patients

Author(s)

Ngaosuwan K.
 Ounchokdee K.
 Chalermchai T.

Abstract

Background: The current international guideline recommended 200 mg/day of hydrocortisone intravenously to treat septic shock. However, a subsequent study on cortisol metabolism actually showed an increase in cortisol level during sepsis. Hence, the smaller hydrocortisone dose of 100 mg/day might be sufficient and reduce steroid-associated complications. We aimed to compare the clinical outcomes of minimized hydrocortisone dose of 100mg to the currently recommended dose in the treatment of septic shock patients. Methods: A double-blinded randomized controlled trial included 80 septic shock patients with hemodynamic instability despite fluid and vasopressive therapy. Participants were divided equally into two groups to treat with 100 mg/day or 200 mg/day of hydrocortisone, then stepwise down titrated and discontinued on day 8. The outcome of interest was the hyperglycemic rate. Vital status, time to shock reversal, superinfection and gastrointestinal bleeding rates were also compared. Results: Patients with 100mg hydrocortisone had significantly lower hyperglycemic rate compared with 200 mg, 63.9% versus 86.5% (the adjusted hazard ratio [HR], 0.08; 95% confidence interval [CI], 0.02-0.41, P=0.002). Time to shock reversal was shorter in patients with 100mg hydrocortisone, 2 days vs. 4 days, P=0.031. The 28-day mortality rate when adjusted for Simplified Acute Physiology Score II showed no significant difference (HR, 0.68; 95% CI, 0.37-1.24, P=0.209). The reinfection and gastrointestinal bleeding rates were comparable between groups. Conclusion: Minimized daily hydrocortisone dosage of 100mg could lower the occurrence of hyperglycemia without increasing mortality in septic shock, compared with the currently recommended dosage of 200 mg/day. Copyright © 2017 by the Shock Society.

Subject(s)

Dopamine
 Epinephrine
 Glucose
 Hydrocortisone sodium succinate
 Noradrenalin
 Hydrocortisone
 Adult
 Article
 Clinical outcome
 Controlled study
 Double blind procedure
 Drug dose reduction
 Drug dose titration
 Drug fatality
 Drug withdrawal
 Female
 Fluid therapy
 Gastrointestinal hemorrhage
 Glucose blood level
 Human
 Hyperglycemia
 Major clinical study
 Male
 Mortality rate
 Outcome assessment
 Parallel design
 Randomized controlled trial
 Recommended drug dose
 Septic shock
 Simplified Acute Physiology Score
 Superinfection
 Aged
 Blood
 Complication
 Disease free survival
 Gastrointestinal hemorrhage
 Hyperglycemia
 Middle aged
 Mortality
 Survival rate
 Time factor
 Very elderly
 Aged
 Aged, 80 and over
 Disease-Free Survival
 Double-Blind Method
 Female
 Gastrointestinal Hemorrhage
 Humans
 Hydrocortisone
 Hyperglycemia
 Male
 Middle Aged
 Shock, Septic
 Survival Rate
 Time Factors

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URI

https://hdl.handle.net/20.500.14740/3816

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Scopus: Year 1983-2021

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