title: Low-dose corticosteroid treatment in septic shock: a propensity-matching study.
abstract: OBJECTIVE
  Given conflicting data and current guidelines, low-dose corticosteroids are often used in the treatment of septic shock. To evaluate the therapeutic benefit of early low-dose corticosteroid in patients with septic shock.
  
  
  METHODS
  Retrospective, multicenter, propensity-matched cohort study.
  
  
  METHODS
  ICUs of 28 academic and community hospitals in three countries between 1996 and 2007.
  
  
  METHODS
  Six thousand six hundred sixty-three eligible patients with septic shock of whom 1,838 received IV low-dose corticosteroid treatment within 48 hours of the diagnosis of septic shock and were matched to a comparable group who did not receive low-dose corticosteroid.
  
  
  RESULTS
  The primary outcome was 30-day mortality. Mortality analyses were stratified by severity of illness (Acute Physiology and Chronic Health Evaluation II quartile). Using a Cox proportional hazards model, corticosteroid therapy was associated with similar 30-day mortality when compared with the matched control cohort (652/1,838 [35.5%] vs 641/1,838 [34.9%]; hazard ratio, 0.98; 95% CI, 0.88-1.10; p = 0.77). In the subgroup of patients with the Acute Physiology and Chronic Health Evaluation II score quartile more than or equal to 30, low-dose corticosteroid was associated with lower mortality (232/461 [50.6%] vs 251/450 [55.8%]; hazard ratio, 0.81; 95% CI, 0.68-0.97; p = 0.02). In logistic regression models, corticosteroid therapy was not associated with reductions in ICU (556/1,838 [30.3%] vs 558/1,838 [30.4%]; odds ratio, 0.99; 95% CI, 0.86-1.15; p = 0.94) or hospital mortality (797/1,838 [43.4%] vs 773/1,838 [42.1%]; odds ratio, 1.05; 95% CI, 0.93-1.20; p = 0.42). Similarly, there were no significant differences in ventilator- (median and interquartile range, 13 [0-25] vs 15 [0-25]; p = 0.8) and pressor/inotrope-free days (median and interquartile range, 25 [3-27] vs 24 [2-28]; p = 0.63) up to 30 days between groups.
  
  
  CONCLUSIONS
  Early administration of low-dose corticosteroid is not associated with decreased mortality when it is administered to unselected patients with septic shock. A beneficial effect of low-dose corticosteroid on mortality may exist in patients with the highest severity of illness. Future trials of low-dose corticosteroid in septic shock should consider restricting the study population to this cohort.
authors: 1Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada. 2Department of Anesthesia, University of Manitoba, Winnipeg, MB, Canada. 3Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada. 4Departments of Medical Microbiology and Pharmacology/Therapeutics, University of Manitoba, Winnipeg, MB, Canada. 5The Center for Health Evaluation and Outcome Sciences and Department of Medicine (PD), St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada. 6Department of Surgery and Critical Care Medicine, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michaels Hospital, The University of Toronto, Toronto, ON, Canada.
authors: Duane
authors: D
authors: Funk
authors: Steven
authors: S
authors: Doucette
authors: Amarnath
authors: A
authors: Pisipati
authors: Peter
authors: P
authors: Dodek
authors: John C
authors: JC
authors: Marshall
authors: Anand
authors: A
authors: Kumar
mesh_terms: D018806:APACHE; D000046:Academic Medical Centers; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D002170:Canada; D016022:Case-Control Studies; D002423:Cause of Death; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006764:Hospitals, Community; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012772:Shock, Septic / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones