(1632) High-Dose Compared to Traditional-Dose Hydrocortisone in Septic Shock

Introduction: Guidelines recommended a dose of intravenous (IV) hydrocortisone (HCT) of 200 mg daily in patients with refractory septic shock. Limited data suggest higher HCT dosing (e.g., 300 mg daily) is associated with faster shock reversal and reduced shock recurrence. We performed this study to evaluate patient outcomes by HCT dosing strategy, given limited available data.

Methods: This was a single-center retrospective study of adult patients admitted to the medical ICU with suspected septic shock, who received at least two vasopressors when IV HCT (TD = 200 mg daily; HD = 300 mg daily) was initiated between 1/2018-8/2023. The primary outcome was time to shock reversal, defined as discontinuation of IV vasopressors for at least four consecutive hours. Our secondary outcome was the incidence of shock recurrence, defined as re-initiation of IV vasopressors for at least 6 continuous hours within 48 hours of shock reversal. Other secondary outcomes included new-onset hyperglycemia, vasopressor change from baseline, hospital and ICU length of stay and mortality.

Results: This study included a total of 153 patients (TD n=108; HD n=45). The cohort had a baseline norepinephrine equivalent dose of 0.43 mcg/kg/min, with 83% on mechanical ventilation. The most common presumed source of sepsis was pneumonia (58.8%). There were no significant differences in baseline characteristics. Patients in the HD group had a shorter time to shock reversal compared to the TD group (53.57 vs. 84.13 hours, p=0.011). There was no difference in incidence of shock reversal (62.04% vs 62.2%, p=0.983) and shock recurrence (27.78% vs 17.78%, p=0.235). There were no differences in incidence of new-onset hyperglycemia, vasopressor change, hospital or ICU length of stay or mortality.

Conclusions: Both doses of hydrocortisone show similar rates of shock reversal regardless of recurrence. High-dose HCT may reduce the time to shock reversal and the time to shock reversal without recurrence.