title: Corticosteroid administration is associated with improved outcome of patients presenting high inflammatory cytokine levels during septic shock.
abstract: BACKGROUND
  This study aimed to investigate the corticosteroid effects on pediatric hematology/oncology patients with septic shock.
  
  
  METHODS
  We performed a retrospective study by examining data from a prospective observational study in pediatric hematology/oncology patients with septic shock. We compared the clinical features and the outcomes of the patients treated with and without corticosteroid.
  
  
  RESULTS
  One hundred episodes of septic shock were recorded in this study. The 28-day mortality of this cohort was 14.0%. Sixty-eight episodes of shock were treated with corticosteroids while 32 were not. The demographic features and disease severity were comparable between patients with and without corticosteroid treatment. Corticosteroid therapy was associated with improved shock reversal rate (92.6% vs. 78.1%, P = 0.049) and decreased 28-day mortality rate (8.8 ± 3.4% vs. 25.0 ± 7.7%, P = 0.032) in univariate analysis. For patients who received vasopressor support, corticosteroid therapy was associated with shortened duration of vasopressor infusion in univariate analysis as well (median: 44 hour vs. 92 hour, P = 0.035). In multivariate analysis, corticosteroid therapy did not show significant impact on the outcome for the whole cohort (HR = 0.36, P = 0.079), but it decreased the 28-day mortality of patients presenting high inflammatory cytokine levels (HR = 0.29, 95% CI, 0.09-0.95, P = 0.040). Corticosteroid administration did not increase the superinfection rate (24.2% vs. 8.3%, P = 0.134) and did not result in superinfection-related death in this cohort.
  
  
  CONCLUSIONS
  Corticosteroid administration is associated with improved outcome in pediatric hematology/oncology patients presenting high inflammatory cytokine levels during septic shock. Pediatr Blood Cancer 2014;61:2243-2248. © 2014 Wiley Periodicals, Inc.
authors.affiliation: Division of Hematology/Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, PR China; Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou, PR China.
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Xu
authors.forename: Yong-Min
authors.initials: YM
authors.lastname: Tang
authors.forename: Hua
authors.initials: H
authors.lastname: Song
authors.forename: Shi-Long
authors.initials: SL
authors.lastname: Yang
authors.forename: Wei-Qun
authors.initials: WQ
authors.lastname: Xu
authors.forename: Shu-Wen
authors.initials: SW
authors.lastname: Shi
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000628:therapy; D006801:Humans; D007223:Infant; D018836:Inflammation Mediators / Q000097:blood*; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D015996:Survival Rate; D013997:Time Factors
chemical_list: D000305:Adrenal Cortex Hormones; D016207:Cytokines; D018836:Inflammation Mediators
keywords: child; corticosteroid; cytokine; hematology/oncology; septic shock