Early corticosteroid use in patients with cardiogenic shock was associated with a 3.1% higher in-hospital mortality (95% CI 2.4% to 3.8%; p<0.001) compared to no early corticosteroids.
Cohort (n=167,721)
Yes
Does early corticosteroid use reduce in-hospital mortality in adult patients with cardiogenic shock?
Early corticosteroid use in patients with cardiogenic shock is associated with increased in-hospital mortality, even among those with concomitant sepsis.
Effect estimate: 3.1% higher mortality (95% CI 2.4% to 3.8%)
Absolute Event Rate: 48.8% vs 29.6%
p-value: p=< 0.001
Background The pathophysiology of CS is complex and is associated with increased inflammation and impaired vascular tone. Corticosteroids are recommended in septic shock and have been proposed as a potential treatment for other types of shock. Objectives We sought to evaluate the clinical outcomes associated with early corticosteroid use in patients with cardiogenic shock (CS). Methods Using a nationally representative database including over 1000 hospitals, we identified adults ≥18 years of age admitted from 2015–2023 with a diagnosis of CS. Patients with adrenal insufficiency, chronic rheumatologic conditions, COVID-19 infection and acute COPD exacerbation were excluded. Using inverse probability treatment weighting (IPTW), we assessed for the association of receiving early corticosteroids (within the first 2 days of admission) versus no early corticosteroids and in-hospital mortality. Results Of the 167,721 identified patients with CS, the mean (SD) age was 65.5 (±15.2) years and 35.0% were women. A total of 13.2% received any corticosteroid within the first 2 days of admission. The most common corticosteroid was hydrocortisone (73.9%). Mortality for those receiving and not receiving early corticosteroids was 48.8% and 29.6% ( p < 0.001), respectively. After IPTW, early corticosteroid use remained associated with a 3.1% (95% confidence interval CI: 2.4% to 3.8%, p < 0.001) higher mortality. Among patients with CS and concomitant sepsis, 27.6% received early corticosteroids, which was similarly associated with a higher mortality (weighted mean 5.8% 95% CI: 4.6% to 7.0%, p < 0.001). Conclusions Approximately 1 in 7 patients with CS received corticosteroids early during their admission, which was associated with higher in-hospital mortality.
Gastanadui et al. (Mon,) conducted a cohort in Cardiogenic shock (n=167,721). Early corticosteroids vs. No early corticosteroids was evaluated on In-hospital mortality (3.1% higher mortality, 95% CI 2.4% to 3.8%, p=< 0.001). Early corticosteroid use in patients with cardiogenic shock was associated with a 3.1% higher in-hospital mortality (95% CI 2.4% to 3.8%; p<0.001) compared to no early corticosteroids.