(1644) Evaluation of Vasopressor Dose at Hydrocortisone Initiation in Septic Shock

Introduction: The 2021 Surviving Sepsis Campaign guidelines recommend corticosteroid initiation after fluid resuscitation and vasopressors have failed to provide adequate tissue perfusion. Limited data available suggests that early initiation of hydrocortisone is beneficial in reducing time to shock reversal and survival, however previous studies have failed to include vasopressor dose as an objective measure to determine corticosteroid initiation.

Methods: The purpose of this study was to evaluate the association between vasopressor requirements at the time of hydrocortisone initiation in patients with septic shock and mortality at 28 days. Secondary endpoints include the association between vasopressor dose at hydrocortisone initiation and vasopressor-free days at day 28, intensive care unit (ICU) length of stay, and hospital length of stay.

This was a retrospective, multicenter, single health system study which evaluated patients admitted to the ICU with septic shock and received hydrocortisone between May 1, 2014 and August 1, 2023. A regression analysis was used to determine the association between vasopressor dose at the time of hydrocortisone initiation and outcomes in septic shock. Data was adjusted for sequential organ failure assessment score and etomidate administration. A two-sided p-value of 0.05 was considered significant.

Results: Results of this study showed that in patients with septic shock, when hydrocortisone was initiated at norepinephrine equivalent doses of less than or equal to 0.1 mcg/kg/min, it was associated with a decreased 28-day mortality (OR: 0.5, 95% CI: 0.37-0.69, P value < 0.001). Secondary endpoints also indicated that when hydrocortisone was initiated at higher norepinephrine equivalent doses, there was an association of decreased vasopressor-free days and increased hospital and ICU lengths of stay.

Conclusions: In patients with septic shock, hydrocortisone initiated at higher norepinephrine equivalent doses was associated with increased 28-day mortality, less vasopressor-free days, and longer ICU and hospital lengths of stay. Results of this study will add to the existing literature by providing clinicians with information on the optimal vasopressor dose at which to initiate hydrocortisone in septic shock to improve outcomes.