Effect of corticosteroids on arginine vasopressin-containing vasopressor therapy for septic shock: a case control study.
OBJECTIVE
Studies showing corticosteroids decrease time to shock reversal in septic shock did not include arginine vasopressin, which also may reduce the duration of catecholamine therapy. Thus, the effect of corticosteroids on vasopressin-containing vasopressor regimens is unknown. We designed this study to evaluate the effect of corticosteroids on time to vasopressin-containing vasopressor withdrawal and the proportion of patients alive without vasopressors at day 7.


METHODS
This retrospective, case-control study included patients admitted to the intensive care units of an academic medical center who received vasopressin-containing vasopressor regimens for septic shock with or without concomitant corticosteroids. Twenty-one corticosteroid-treated patients were matched to those without corticosteroids.


RESULTS
Both groups had similar Acute Physiology And Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II, and Sequential Organ Failure Assessment (SOFA) scores. There was no significant difference in median time to vasopressor withdrawal (65 hours vs 20 hours, P = .09) whether corticosteroids were given or withheld. Patients who received corticosteroids, however, were significantly more likely alive without vasopressors at day 7 than patients who received a vasopressin-containing vasopressor regimen alone (80.9% vs 47.6%, P = .02).


CONCLUSIONS
Although corticosteroids did not improve the time to withdrawal of vasopressin-containing vasopressor therapy they significantly increased the proportion of patients alive without vasopressors at day 7.
Bauer
Seth R
SR
Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio 44195, USA. bauers@ccf.org
Lam
Simon W
SW
Cha
Stephen S
SS
Oyen
Lance J
LJ
D018806:APACHE; D000046:Academic Medical Centers; D000368:Aged; D001127:Arginine Vasopressin / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005438:Fludrocortisone / Q000008:administration & dosage / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D005938:Glucocorticoids; D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin; D005438:Fludrocortisone; D006854:Hydrocortisone