Clinical Outcomes of Minimized Hydrocortisone Dosage of 100 mg/day on Lower Occurrence of Hyperglycemia in Septic Shock Patients
The current international guideline recommended 200 mg per day of hydrocortisone intravenously to treat septic shock. However, a subsequent study on cortisol metabolism actually showed an increase in cortisol level during sepsis. Hence, the smaller hydrocortisone dose of 100 mg per day might be sufficient and reduce steroid-associated complications. We aimed to compare the clinical outcomes of minimized hydrocortisone dose of 100 mg to the currently recommended dose in the treatment of septic shock patients.Methods:
A double-blinded randomized controlled trial included 80 septic shock patients with hemodynamic instability despite fluid and vasopressive therapy. Participants were divided equally into two groups to treat with 100 mg or 200 mg per day of hydrocortisone, then stepwise down titrated and discontinued on day 8. The outcome of interest was the hyperglycemic rate. Vital status, time to shock reversal, superinfection and gastrointestinal bleeding rates were also compared.Results:
Patients with 100 mg hydrocortisone had significantly lower hyperglycemic rate compared to 200 mg, 63.9% VS 86.5% (the adjusted Hazard Ratio [HR], 0.08; 95% Confidence Interval [CI], 0.02–0.41, P=0.002). Time to shock reversal was shorter in patients with 100 mg hydrocortisone, 2 days VS 4 days, P = 0.031. The 28-day mortality rate when adjusted for SAPS II showed no significant difference (HR, 0.68; 95% CI, 0.37–1.24, P = 0.209). The reinfection and gastrointestinal bleeding rates were comparable between groups.Conclusion:
Minimized daily hydrocortisone dosage of 100 mg could lower the occurrence of hyperglycemia without increasing mortality in septic shock, compared to the currently recommended dosage of 200 mg per day.