(1627) Evaluation of Steroid Choice on Vasopressor Requirements During a Hydrocortisone Shortage

Introduction: Steroids are used in septic shock to improve outcomes such as time to shock reversal, time on mechanical ventilation, and length of hospital stay. However, there is a paucity of data on alternative steroid choice and dosing in the setting of shock. The primary outcome of this study is to investigate the effect of dexamethasone and hydrocortisone on shock resolution, defined as 24 hours off vasopressors after steroid initiation.

Methods: This is a single center, retrospective, pre-post analysis of patients admitted to an intensive care unit (ICU) with septic shock requiring vasopressor and corticosteroid treatment. The pre-intervention group included treatment with hydrocortisone 50 mg intravenous every six hours from March 2022 to August 2022, and the post-intervention group included treatment with dexamethasone 8 mg intravenous daily from March 2023 to August 2023.

Results: Of the 242 patients meeting criteria, 164 were included, with 101 in the hydrocortisone arm and 63 in the dexamethasone arm. Majority of patients (79.8% ) were admitted to the medical ICU and 53.6% were on high dose norepinephrine (>0.2 mcg/kg/min) when steroids were initiated. Median sequential organ failure assessment (SOFA) score was 12 in the hydrocortisone group and 11 in the dexamethasone group (p < 0.01). More patients achieved the primary outcome of shock resolution in the dexamethasone group versus the hydrocortisone group (32 [50.8%] vs 36 [35.6%]; p=0.06). Median ICU length of stay was 7.4 days in the hydrocortisone group vs 6.8 days in the dexamethasone group (p=0.81). 28-day all-cause mortality was not significant between both groups, occurring in 74.3% of hydrocortisone patients and 63.5% of dexamethasone patients (p=0.14).

Conclusions: No statistically significant differences were observed in shock resolution, mortality rates, or length of stay, indicating that dexamethasone may be an appropriate alternative to hydrocortisone in septic shock.