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Annals of Intensive Care

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Open Access 01-12-2015 | Research

Low-dose corticosteroid treatment and mortality in refractory abdominal septic shock after emergency laparotomy

Authors: Takashi Tagami, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga

Published in: Annals of Intensive Care | Issue 1/2015

Abstract

Background

The role of low-dose corticosteroid as an adjunctive treatment for abdominal septic shock remains controversial.

Methods

We identified refractory septic shock patients who required noradrenaline and at least one of other vasopressor/inotropic (dopamine, dobutamine or vasopressin) following emergency open laparotomy for perforation of the lower intestinal tract between July 2010 and March 2013 using the Japanese Diagnosis Procedure Combination inpatient database. In-hospital mortality was compared between the low-dose corticosteroid and control groups.

Results

There were 2164 eligible patients (155 in the corticosteroid group, 2009 in the control group). We observed no significant difference between the groups in terms of in-hospital mortality in the unadjusted analysis [corticosteroid vs. control groups, 19.4 and 25.1 %, respectively; difference, −5.7 %; 95 % confidence interval (CI), −12.8 to 1.3]; however, a significant difference in in-hospital mortality was evident in the propensity score-weighted analysis (17.6 and 25.0 %, respectively; difference, −7.4 %; 95 % CI −9.9 to −5.0). An instrumental variable analysis with the hospital low-dose corticosteroid prescription proportion showed that receipt of low-dose corticosteroid was significantly associated with reduction in in-hospital mortality (differences, −13.5 %; 95 % CI −24.6 to −2.3).

Conclusions

Low-dose corticosteroid administration may be associated with reduced in-hospital mortality in patients with refractory septic shock following emergency laparotomy for lower intestinal perforation.

Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580–637.CrossRefPubMed

Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369:840–51.CrossRefPubMed

Daviaud F, Grimaldi D, Dechartres A, Charpentier J, Geri G, Marin N, et al. Timing and causes of death in septic shock. Ann Intensive Care. 2015;5:58.CrossRefPubMed

Marik PE, Pastores SM, Annane D, Meduri GU, Sprung CL, Arlt W, et al. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med. 2008;36:1937–49.CrossRefPubMed

Annane D. Corticosteroids for severe sepsis: an evidence-based guide for physicians. Ann Intensive Care. 2011;1:7.PubMedCentralCrossRefPubMed

Dejager L, Pinheiro I, Dejonckheere E, Libert C. Cecal ligation and puncture: the gold standard model for polymicrobial sepsis? Trends Microbiol. 2011;19:198–208.CrossRefPubMed

Oberbeck R, Dahlweid M, Koch R, van Griensven M, Emmendorfer A, Tscherne H, et al. Dehydroepiandrosterone decreases mortality rate and improves cellular immune function during polymicrobial sepsis. Crit Care Med. 2001;29:380–4.CrossRefPubMed

Hollenbach SJ, DeGuzman LR, Bellamy RF. Early administration of methylprednisolone promotes survival in rats with intra-abdominal sepsis. Circ Shock. 1986;20:161–8.PubMed

Koo DJ, Jackman D, Chaudry IH, Wang P. Adrenal insufficiency during the late stage of polymicrobial sepsis. Crit Care Med. 2001;29:618–22.CrossRefPubMed

10.

Torres A, Sibila O, Ferrer M, Polverino E, Menendez R, Mensa J, et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: a randomized clinical trial. JAMA. 2015;313:677–86.CrossRefPubMed

11.

Wang C, Sun J, Zheng J, Guo L, Ma H, Zhang Y, et al. Low-dose hydrocortisone therapy attenuates septic shock in adult patients but does not reduce 28-day mortality: a meta-analysis of randomized controlled trials. Anesth Analg. 2014;118:346–57.CrossRefPubMed

12.

Sligl WI, Milner DA Jr, Sundar S, Mphatswe W, Majumdar SR. Safety and efficacy of corticosteroids for the treatment of septic shock: a systematic review and meta-analysis. Clin Infect Dis. 2009;49:93–101.CrossRefPubMed

13.

Patel GP, Balk RA. Systemic steroids in severe sepsis and septic shock. Am J Respir Crit Care Med. 2012;185:133–9.CrossRefPubMed

14.

Annane D, Cariou A, Maxime V, Azoulay E, D’Honneur G, Timsit JF, et al. Corticosteroid treatment and intensive insulin therapy for septic shock in adults: a randomized controlled trial. JAMA. 2010;303:341–8.CrossRefPubMed

15.

Annane D, Bellissant E, Bollaert PE, Briegel J, Confalonieri M, De Gaudio R, et al. Corticosteroids in the treatment of severe sepsis and septic shock in adults: a systematic review. JAMA. 2009;301:2362–75.CrossRefPubMed

16.

Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002;288:862–71.CrossRefPubMed

17.

Sprung CL, Annane D, Keh D, Moreno R, Singer M, Freivogel K, et al. Hydrocortisone therapy for patients with septic shock. N Engl J Med. 2008;358:111–24.CrossRefPubMed

18.

Casserly B, Gerlach H, Phillips GS, Lemeshow S, Marshall JC, Osborn TM, et al. Low-dose steroids in adult septic shock: results of the Surviving Sepsis Campaign. Intensive Care Med. 2012;38:1946–54.CrossRefPubMed

19.

Minneci PC, Deans KJ, Eichacker PQ, Natanson C. The effects of steroids during sepsis depend on dose and severity of illness: an updated meta-analysis. Clin Microbiol Infect. 2009;15:308–18.PubMedCentralCrossRefPubMed

20.

Volbeda M, Wetterslev J, Gluud C, Zijlstra JG, van der Horst IC, Keus F. Glucocorticosteroids for sepsis: systematic review with meta-analysis and trial sequential analysis. Intensive Care Med. 2015;41:1220–34.PubMedCentralCrossRefPubMed

21.

Friend KE, Burgess JN, Britt RC, Collins JN, Weireter LN, Novosel TJ, et al. Procalcitonin elevation suggests a septic source. Am Surg. 2014;80:906–9.PubMed

22.

Ani C, Farshidpanah S, Bellinghausen Stewart A, Nguyen HB. Variations in organism-specific severe sepsis mortality in the United States. Crit Care Med. 2015;43:65–77.CrossRefPubMed

23.

Hubbard WJ, Choudhry M, Schwacha MG, Kerby JD, Rue LW, Bland KI, et al. Cecal ligation and puncture. Shock. 2005;24:52–7.CrossRefPubMed

24.

Tagami T, Matsui H, Fushimi K, Yasunaga H. Intravenous immunoglobulin and mortality in pneumonia patients with septic shock: an Observational Nationwide Study. Clin Infect Dis. 2015;61:385–92.CrossRefPubMed

25.

Tagami T, Matsui H, Fushimi K, Yasunaga H. Use of recombinant human soluble thrombomodulin in patients with sepsis-induced disseminated intravascular coagulation after intestinal perforation. Front Med (Lausanne). 2015;2:7.PubMedCentralPubMed

26.

Tagami T, Matsui H, Fushimi K, Yasunaga H. Supplemental dose of antithrombin use in disseminated intravascular coagulation patients after abdominal sepsis. Thromb Haemost. 2015;114:537–45.CrossRefPubMed

27.

Tagami T, Matsui H, Horiguchi H, Fushimi K, Yasunaga H. Low-dose corticosteroid use and mortality in severe community-acquired pneumonia patients. Eur Respir J. 2015;45:463–72.CrossRefPubMed

28.

Funk D, Doucette S, Pisipati A, Dodek P, Marshall JC, Kumar A, et al. Low-dose corticosteroid treatment in septic shock: a propensity-matching study. Crit Care Med. 2014;42:2333–41.CrossRefPubMed

29.

Bernard GR, Luce JM, Sprung CL, Rinaldo JE, Tate RM, Sibbald WJ, et al. High-dose corticosteroids in patients with the adult respiratory distress syndrome. N Engl J Med. 1987;317:1565–70.CrossRefPubMed

30.

Schoenfeld DA, Bernard GR. Statistical evaluation of ventilator-free days as an efficacy measure in clinical trials of treatments for acute respiratory distress syndrome. Crit Care Med. 2002;30:1772–7.CrossRefPubMed

31.

Curtis LH, Hammill BG, Eisenstein EL, Kramer JM, Anstrom KJ. Using inverse probability-weighted estimators in comparative effectiveness analyses with observational databases. Med Care. 2007;45:S103–7.CrossRefPubMed

32.

Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res. 2011;46:399–424.CrossRef

33.

Tagami T, Tosa R, Omura M, Fukushima H, Kaneko T, Endo T, et al. Effect of a selective neutrophil elastase inhibitor on mortality and ventilator-free days in patients with increased extravascular lung water: a post hoc analysis of the PiCCO Pulmonary Edema Study. J Intensive Care. 2014;2:69.CrossRef

34.

Staiger D, Stock JH. Instrumental variables regression with weak instruments. Econometrica. 1994;65:557–86.CrossRef

35.

Marik PE. Critical illness-related corticosteroid insufficiency. Chest. 2009;135:181–93.CrossRefPubMed

36.

Contrael KM, Killian AJ, Gregg SR, Buchman TG, Coopersmith CM. Prescribing patterns of hydrocortisone in septic shock: a single-center experience of how surviving sepsis guidelines are interpreted and translated into bedside practice. Crit Care Med. 2013;41:2310–7.CrossRefPubMed

37.

Tagami T, Nakamura T, Kushimoto S, Tosa R, Watanabe A, Kaneko T, et al. Early-phase changes of extravascular lung water index as a prognostic indicator in acute respiratory distress syndrome patients. Ann Intensive Care. 2014;4:27.PubMedCentralCrossRefPubMed

38.

Austin PC. The use of propensity score methods with survival or time-to-event outcomes: reporting measures of effect similar to those used in randomized experiments. Stat Med. 2014;33:1242–58.PubMedCentralCrossRefPubMed

Title: Low-dose corticosteroid treatment and mortality in refractory abdominal septic shock after emergency laparotomy
Authors: Takashi Tagami
Hiroki Matsui
Kiyohide Fushimi
Hideo Yasunaga
Publication date: 01-12-2015
Publisher: Springer Paris
Published in: Annals of Intensive Care / Issue 1/2015
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-015-0074-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Low-dose corticosteroid treatment and mortality in refractory abdominal septic shock after emergency laparotomy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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