TY - JOUR
T1 - Clinical Effect of Systemic Steroids in Patients with Cirrhosis and Septic Shock
AU - Piccolo Serafim, Laura
AU - Simonetto, Douglas A.
AU - Anderson, Alexandra L.
AU - Choi, Dae Hee
AU - Weister, Timothy J.
AU - Hanson, Andrew C.
AU - Kamath, Patrick S.
AU - Gajic, Ognjen
AU - Gallo De Moraes, Alice
N1 - Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Purpose:Evidence regarding the utility of systemic steroids in treating patients with cirrhosis and septic shock remains equivocal. This study aimed to evaluate and elucidate the association of steroid use with outcomes and adverse effects in a cohort of patients with cirrhosis and septic shock.Patients and methods:Retrospective cohort study of patients with cirrhosis and septic shock admitted to a tertiary hospital intensive care unit (ICU) from January 2007 to May 2017, using a validated ICU Datamart. Patients who received vasopressors within 6 h of ICU admission were included in the multivariate analysis. The effect of steroids on outcomes was evaluated using multivariable regression, adjusting for confounding variables.Results:Out of 179 admissions of patients with cirrhosis and septic shock, 56 received steroids during the ICU admission. Patients who received steroids received a higher total dose of vasopressors (91.2 mg vs. 39.1 mg, P = 0.04) and had a lower initial lactate level (1.8 mmol/L vs. 2.6 mmol/L, P = 0.007). The multivariate analysis included 117 patients and showed no significant differences in mortality, length of ICU admission, or length of hospital stay. Bleeding events, delirium, and renal-replacement therapy requirements were also not associated with the use of steroids.Conclusion:The use of systemic steroids was more prevalent in cirrhotic patients with higher vasopressor requirements. It was not associated with decreased mortality or increased ICU- and hospital-free days, or to adverse effects.
AB - Purpose:Evidence regarding the utility of systemic steroids in treating patients with cirrhosis and septic shock remains equivocal. This study aimed to evaluate and elucidate the association of steroid use with outcomes and adverse effects in a cohort of patients with cirrhosis and septic shock.Patients and methods:Retrospective cohort study of patients with cirrhosis and septic shock admitted to a tertiary hospital intensive care unit (ICU) from January 2007 to May 2017, using a validated ICU Datamart. Patients who received vasopressors within 6 h of ICU admission were included in the multivariate analysis. The effect of steroids on outcomes was evaluated using multivariable regression, adjusting for confounding variables.Results:Out of 179 admissions of patients with cirrhosis and septic shock, 56 received steroids during the ICU admission. Patients who received steroids received a higher total dose of vasopressors (91.2 mg vs. 39.1 mg, P = 0.04) and had a lower initial lactate level (1.8 mmol/L vs. 2.6 mmol/L, P = 0.007). The multivariate analysis included 117 patients and showed no significant differences in mortality, length of ICU admission, or length of hospital stay. Bleeding events, delirium, and renal-replacement therapy requirements were also not associated with the use of steroids.Conclusion:The use of systemic steroids was more prevalent in cirrhotic patients with higher vasopressor requirements. It was not associated with decreased mortality or increased ICU- and hospital-free days, or to adverse effects.
KW - Cirrhosis
KW - critical care
KW - sepsis
KW - septic shock
KW - steroids
UR - http://www.scopus.com/inward/record.url?scp=85121957955&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85121957955&partnerID=8YFLogxK
U2 - 10.1097/SHK.0000000000001822
DO - 10.1097/SHK.0000000000001822
M3 - Article
C2 - 34132218
AN - SCOPUS:85121957955
SN - 1073-2322
VL - 56
SP - 916
EP - 920
JO - Shock
JF - Shock
IS - 6
ER -