Comparison of hydrocortisone 100 mg bolus plus 200 mg/day infusion vs. infusion alone in refractory septic shock

TL;DR

This study compared two hydrocortisone treatment regimens for septic shock and found no significant difference in outcomes when a bolus dose was added.

Contribution

The study provides evidence that adding a hydrocortisone bolus to standard treatment does not improve outcomes in refractory septic shock.

Findings

No significant difference in vasopressor duration between bolus and non-bolus groups.

Shock reversal rates were similar in both treatment groups.

Secondary outcomes like mortality and hospital stay showed no significant differences.

Abstract

Current guidelines recommend the addition of hydrocortisone 200 mg/day for the treatment of septic shock unresponsive to fluids and vasopressors. However, the benefits of adding a 100 mg bolus to this regimen remain unclear. The study assessed the efficacy of the administration of hydrocortisone 200 mg/day with or without a 100 mg bolus in refractory septic shock.

This retrospective cohort study included adult patients with refractory septic shock treated at a tertiary care center between 2019 and 2023. Patients were divided into bolus group (receiving a 100 mg hydrocortisone bolus followed by a 200 mg/day continuous infusion) and non-bolus group (receiving a continuous infusion of 200 mg/day without the addition of a bolus) based on physician decision. The primary outcomes were the duration of vasopressor and shock reversal. Secondary outcomes included 28-day mortality and length of hospital stay. Comparisons between groups were performed using chi-squared tests, t-tests, and Kaplan–Meier survival analysis.

A total of 184 patients were included, 149 patients in the bolus group and 35 patients in the non-bolus group. The median vasopressor duration was 1 (interquartile range [IQR]: 1–2) days in both groups (P=0.967). Shock reversal occurred in 79.9 % of the bolus group and 82.9 % of the non-bolus group (OR=0.82, 95% CI: 0.30 to 2.23, P=0.688). Secondary outcomes in the bolus group and non-bolus group, including 28-day mortality (30.2 % vs. 22.9 %, OR=1.46, 95% CI: 0.62 to 3.43, P=0.745) and hospital length of stay (9 [IQR: 6-17] days vs. 11 [IQR: 5-15] days, P=0.875), did not show any significant differences. Kaplan–Meier survival analysis showed no difference in 28-day survival between groups (HR=1.29, 95% CI: 0.73 to 2.30, P=0.373).

The addition of a 100 mg bolus to a 200 mg/day hydrocortisone regimen may not impact clinical outcomes in refractory septic shock.

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