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Corticosteroids and pediatric septic shock outcomes: a risk stratified analysis
Sarah J Atkinson1, Natalie Z Cvijanovich2, Neal J Thomas3
1Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, OH, United States of America; Department of Surgery, University of Cincinnati, Cincinnati, OH, United States of America.
Insights
Corticosteroids did not improve outcomes in children with septic shock, regardless of initial mortality risk. This study found no benefit for pediatric septic shock patients receiving corticosteroids.
Area of Science:
- Pediatric critical care medicine
- Septic shock research
- Clinical pharmacology
Background:
- Corticosteroid effectiveness in septic shock may be risk-dependent.
- Previous studies suggest potential benefits, but evidence in pediatric populations is limited.
- Stratifying patients by initial mortality risk is crucial for understanding treatment efficacy.
Purpose of the Study:
- To determine the association between corticosteroid use and outcomes in pediatric septic shock.
- To investigate if initial mortality risk modifies the effect of corticosteroids.
- To stratify pediatric septic shock patients using the PERSEVERE tool and analyze corticosteroid impact.
Main Methods:
- Retrospective analysis of a multi-center pediatric septic shock database.
- Stratification of 496 subjects into low, intermediate, and high mortality risk strata using PERSEVERE.
- Comparison of outcomes (28-day mortality, complicated course) between corticosteroid recipients (n=252) and non-recipients (n=244) via logistic regression.
Main Results:
- Corticosteroid use was associated with higher organ failure, illness severity, mortality, and need for vasoactive medications.
- Overall, corticosteroids increased the risk of mortality (OR 2.3) and complicated course (OR 1.7).
- No significant benefit of corticosteroids was observed within any risk stratum, by comorbidity status, or PRISM score.
Conclusions:
- Risk stratification did not reveal any benefit of corticosteroid administration in pediatric septic shock.
- Corticosteroids were associated with increased mortality and complicated course in this cohort.
- Further research is needed to clarify the role of corticosteroids in pediatric septic shock management.
Background:
The potential benefits of corticosteroids for septic shock may depend on initial mortality risk.
Objective:
We determined associations between corticosteroids and outcomes in children with septic shock who were stratified by initial mortality risk.
Methods:
We conducted a retrospective analysis of an ongoing, multi-center pediatric septic shock clinical and biological database. Using a validated biomarker-based stratification tool (PERSEVERE), 496 subjects were stratified into three initial mortality risk strata (low, intermediate, and high). Subjects receiving corticosteroids during the initial 7 days of admission (n = 252) were compared to subjects who did not receive corticosteroids (n = 244). Logistic regression was used to model the effects of corticosteroids on 28-day mortality and complicated course, defined as death within 28 days or persistence of two or more organ failures at 7 days.
Results:
Subjects who received corticosteroids had greater organ failure burden, higher illness severity, higher mortality, and a greater requirement for vasoactive medications, compared to subjects who did not receive corticosteroids. PERSEVERE-based mortality risk did not differ between the two groups. For the entire cohort, corticosteroids were associated with increased risk of mortality (OR 2.3, 95% CI 1.3-4.0, p = 0.004) and a complicated course (OR 1.7, 95% CI 1.1-2.5, p = 0.012). Within each PERSEVERE-based stratum, corticosteroid administration was not associated with improved outcomes. Similarly, corticosteroid administration was not associated with improved outcomes among patients with no comorbidities, nor in groups of patients stratified by PRISM.
Conclusions:
Risk stratified analysis failed to demonstrate any benefit from corticosteroids in this pediatric septic shock cohort.
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