Introduction
The CORTICUS trial doubts the value of hydrocortisone replacement for final outcome of septic shock [1]. We hypothesized that the time of starting hydrocortisone may impact on the final outcome.
Methods
Retrospective analysis was made of prospectively collected data for 41 patients with septic shock (ACCP/SCCM 1992 definition) in the past year in two ICUs. Hydrocortisone was infused as suggested [2]. The time lapsing from start of vasopressors until start of hydrocortisone was determined by the patients' charts.
Results
Early start of hydrocortisone was determined by the quartiles of lapsing time as less than 24 hours. The impact of early start is shown in Figure 1. The mean APACHE II score for patients in early start was 22.09 and for patients in late start was 18.33 (P = NS). Cox regression analysis revealed that the only factor affecting final outcome was early start of hydrocortisone (HR: 4.85, 95% CI: 1.11 to 21.22, P = 0.036) as opposed to appropriateness of antimicrobial treatment (HR: 2.80, 95% CI: 0.56 to 13.91, P = NS).
Survival in relation to start of hydrocortisone.
Conclusions
Despite the observational approach, early start of hydrocortisone replacement in septic shock is a critical factor for outcome.
References
Sprung CL, et al.: N Engl J Med. 2008, 358: 111. 10.1056/NEJMoa071366
Marik PE, et al.: Crit Care Med. 2008, 36: 1937. 10.1097/CCM.0b013e31817603ba
Author information
Authors and Affiliations
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Katsenos, C., Tsagkaris, I., Antonopoulou, A. et al. Early administration of hydrocortisone replacement after advent of septic shock is a major determinant of final outcome. Crit Care 15 (Suppl 1), P412 (2011). https://doi.org/10.1186/cc9832
Published:
DOI: https://doi.org/10.1186/cc9832