Corticosteroids and pediatric septic shock outcomes: a risk stratified analysis.
BACKGROUND
The potential benefits of corticosteroids for septic shock may depend on initial mortality risk.


OBJECTIVE
We determined associations between corticosteroids and outcomes in children with septic shock who were stratified by initial mortality risk.


METHODS
We conducted a retrospective analysis of an ongoing, multi-center pediatric septic shock clinical and biological database. Using a validated biomarker-based stratification tool (PERSEVERE), 496 subjects were stratified into three initial mortality risk strata (low, intermediate, and high). Subjects receiving corticosteroids during the initial 7 days of admission (n = 252) were compared to subjects who did not receive corticosteroids (n = 244). Logistic regression was used to model the effects of corticosteroids on 28-day mortality and complicated course, defined as death within 28 days or persistence of two or more organ failures at 7 days.


RESULTS
Subjects who received corticosteroids had greater organ failure burden, higher illness severity, higher mortality, and a greater requirement for vasoactive medications, compared to subjects who did not receive corticosteroids. PERSEVERE-based mortality risk did not differ between the two groups. For the entire cohort, corticosteroids were associated with increased risk of mortality (OR 2.3, 95% CI 1.3-4.0, p = 0.004) and a complicated course (OR 1.7, 95% CI 1.1-2.5, p = 0.012). Within each PERSEVERE-based stratum, corticosteroid administration was not associated with improved outcomes. Similarly, corticosteroid administration was not associated with improved outcomes among patients with no comorbidities, nor in groups of patients stratified by PRISM.


CONCLUSIONS
Risk stratified analysis failed to demonstrate any benefit from corticosteroids in this pediatric septic shock cohort.
Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, OH, United States of America; Department of Surgery, University of Cincinnati, Cincinnati, OH, United States of America.
Sarah J
SJ
Atkinson
UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States of America.
Natalie Z
NZ
Cvijanovich
Penn State Hershey Children's Hospital, Hershey, PA, United States of America.
Neal J
NJ
Thomas
Children's Mercy Hospital, Kansas City, MO, United States of America.
Geoffrey L
GL
Allen
Children's Hospital of Orange County, Orange, CA, United States of America.
Nick
N
Anas
Akron Children's Hospital, Akron, OH, United States of America.
Michael T
MT
Bigham
Nationwide Children's Hospital, Columbus, OH, United States of America.
Mark
M
Hall
Children's National Medical Center, Washington, DC, United States of America.
Robert J
RJ
Freishtat
Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, United States of America.
Anita
A
Sen
Miami Children's Hospital, Miami, FL, United States of America.
Keith
K
Meyer
Texas Children's Hospital, Houston, TX, United States of America.
Paul A
PA
Checchia
C. S. Mott Children's Hospital at the University of Michigan, Ann Arbor, MI, United States of America.
Thomas P
TP
Shanley
Children's Hospital and Clinics of Minnesota, Minneapolis, MN, United States of America.
Jeffrey
J
Nowak
C. S. Mott Children's Hospital at the University of Michigan, Ann Arbor, MI, United States of America.
Michael
M
Quasney
The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America.
Scott L
SL
Weiss
Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, OH, United States of America.
Sharon
S
Banschbach
Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, OH, United States of America.
Eileen
E
Beckman
Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, OH, United States of America.
Kelli
K
Howard
Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, OH, United States of America.
Erin
E
Frank
Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, OH, United States of America.
Kelli
K
Harmon
Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, OH, United States of America.
Patrick
P
Lahni
Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America.
Christopher J
CJ
Lindsell
Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, OH, United States of America; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America.
Hector R
HR
Wong
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D012772:Shock, Septic / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones