Abrupt versus gradual cessation of steroids in patients with septic shock

To determine if a difference in hemodynamic stability would be identified in patients with abrupt withdrawal of steroids compared to patients who underwent a taper.

This retrospective cohort study identified patients who received vasopressors followed by IV hydrocortisone for treatment of septic shock from January 1, 2013 until January 1, 2015.The primary endpoint evaluated the percent of patients requiring vasopressor re-initiation during taper and 72 h following taper, or 72 h directly following abrupt withdrawal. Secondary endpoints evaluated include glycemic control, and ICU length of stay.

A total of 87 patients were included for final analysis. Of the 87 patients, 7 out of 41 patients (17.1%) in the steroid taper group developed hemodynamic instability and required re-initiation of vasopressors compared to 1 out of 46 patients (2.2%) in the abrupt withdrawal group (p = 0.024). Patients in the taper group also had worse glycemic control (125.1 mg/dL abrupt vs. 150.8 taper; p < 0.001). There was no statistical difference found in the ICU length of stay (8.28 days abrupt vs.10.73 taper; p = 0.14).

The abrupt withdrawal of steroids in patients with resolving septic shock did not impact hemodynamic stability and offers an opportunity to reduce medication burden and reduce adverse drug reactions.