# 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.

## Key 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.