Hydrocortisone versus vasopressin for the management of adult patients with septic shock refractory to norepinephrine: A multicenter retrospective study

Steven Kulesza; Lindsey Gignac; C. Allis Colvin; Skyler Boll; Christopher Giuliano; Bradley Haan; B.R. Allen; Mary M. Perez; Monica Allen; Stephanie B. Edwin

doi:10.1002/phar.2811

May 6, 2023Pharmacotherapy The Journal of Human Pharmacology and Drug TherapyOpen Access

Hydrocortisone versus vasopressin for the management of adult patients with septic shock refractory to norepinephrine: A multicenter retrospective study

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Key Points

Compare clinical outcomes between hydrocortisone and vasopressin when used as second-line adjuncts in adult patients with septic shock requiring escalating doses of norepinephrine.
Multicenter, retrospective, observational study of 768 adult patients with presumed septic shock receiving norepinephrine across 10 Ascension Health hospitals between December 2015 and August 2021.
Patients received adjunctive hydrocortisone (200–300 mg/day) or vasopressin (0.03–0.04 units/min), with outcomes evaluated using multivariable regression and propensity score matching.
Hydrocortisone adjunct therapy significantly reduced 28-day mortality compared with vasopressin after controlling for confounders (OR 0.46, 95% CI 0.32–0.66), with similar findings after propensity score matching.
Hydrocortisone achieved higher hemodynamic responsiveness (91.9% vs. 68.2%, p < 0.01) and shock resolution (68.8% vs. 31.5%, p < 0.01) compared with vasopressin.
Recurrence of shock within 72 hours was significantly lower with hydrocortisone than with vasopressin (8.7% vs. 20.7%, p < 0.01).

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Implication

Multicenter retrospective study reveals lower 28-day mortality with hydrocortisone versus vasopressin in norepinephrine-refractory septic shock, highlighting its utility as a second-line therapy.

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Kulesza et al. (2023) studied this question.

synapsesocial.com/papers/6a9883c951bfb7cc6ad74425 https://doi.org/10.1002/phar.2811

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Hydrocortisone versus vasopressin for the management of adult patients with septic shock refractory to norepinephrine: A multicenter retrospective study

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Hydrocortisone versus vasopressin for the management of adult patients with septic shock refractory to norepinephrine: A multicenter retrospective study

Key Points

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Implication

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Cite This Study

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