(1566) Tapered Versus Abrupt Discontinuation of Hydrocortisone in Patients With Septic Shock

Introduction: The Surviving Sepsis guidelines suggest utilization of intravenous corticosteroids as an adjunctive treatment option for patients with septic shock requiring ongoing vasopressor support. While guidelines for initiation of therapy exist, there is no clear recommendation for optimal discontinuation methods of hydrocortisone. The 2016 Surviving Sepsis Guidelines suggested that discontinuation of hydrocortisone should be tapered upon vasopressor cessation; however, the 2021 update removed such recommendation. Limited data exist evaluating the effect of hydrocortisone discontinuation methods in septic shock. The aim of this study is to evaluate the clinical impact of abrupt versus tapered discontinuation of hydrocortisone in septic shock patients.

Methods: This was a multicenter retrospective cohort study conducted in various intensive care units (ICU) among a large community hospital system. Adult patients admitted to the ICU with septic shock initiated on either 200 mg or 300 mg of hydrocortisone a day were evaluated. Patients meeting eligibility requirements were divided into two study arms, one arm receiving a steroid taper and the other arm with abrupt steroid discontinuation. The primary outcome evaluated hemodynamic instability after discontinuation of hydrocortisone. Hemodynamic instability was defined as the reinitiation of vasopressors after discontinuation of hydrocortisone. Secondary outcomes evaluated included: ICU length of stay, incidence of hyperglycemia, hypernatremia, and muscle weakness.

Results: Of the 118 patients meeting inclusion criteria, 34 patients met criteria for the hydrocortisone taper arm and 84 patients met criteria for the abrupt discontinuation arm. Baseline demographics were similar between groups except for initial hydrocortisone doses. There was no difference in hemodynamic instability between the taper arm and abrupt arm (11.76% versus 11.9%; p = 0.619). Secondary outcomes were similar between groups for ICU length of stay, incidence of hyperglycemia, and incidence of muscle weakness. There was a higher incidence of hypernatremia in the taper arm (47.1% vs. 22.9%; p = 0.01).

Conclusions: Among patients with septic shock, there were no significant differences in hemodynamic instability between tapered and abrupt hydrocortisone discontinuation methods.