Evaluation of Hydrocortisone Discontinuation Strategies in Septic Shock: A Retrospective Cohort Study

While corticosteroid administration in septic shock has been shown to reduce vasopressor requirements and accelerate shock reversal, the optimal discontinuation strategy remains unexplored.

The purpose of this study was to assess whether rates of hemodynamic instability differ among patients with septic shock undergoing abrupt hydrocortisone discontinuation compared with gradual tapering.

A retrospective cohort study conducted in five medical and surgical ICUs at a tertiary care hospital, involving adult patients (≥ 18 yr) with septic shock who received at least 48 hours of stress-dose hydrocortisone (≥ 200 mg/d).

The primary outcome was hemodynamic instability, defined as vasopressor reinitiation during tapering or within 72 hours of hydrocortisone discontinuation. Secondary outcomes included dysglycemia, duration of mechanical ventilation, ICU and hospital length of stay, and mortality.

Patients were grouped based on their hydrocortisone discontinuation strategy into abrupt and gradual tapering groups. A total of 414 patients were included in this evaluation. Gradual tapering was associated with higher rates of hemodynamic instability (29.2% vs. 12.9%; p < 0.001), more frequent dysglycemia (59.4% vs. 43.1%; p < 0.001), longer hydrocortisone use (9.9 vs. 4.1 d; p < 0.001), and extended mechanical ventilation (20 vs. 15 d; p = 0.014) and ICU stay (23 vs. 17 d; p = 0.008). Total hydrocortisone duration was the strongest independent predictor of post-discontinuation hemodynamic instability, regardless of strategy (adjusted odds ratio, 1.083; 95% CI, 1.025-1.145; p = 0.004).

While abrupt hydrocortisone discontinuation was associated with fewer ICU-related adverse events, hydrocortisone duration was the primary factor influencing hemodynamic instability post-discontinuation among patients with septic shock. Prospective studies are needed to determine the optimal discontinuation strategy in septic shock.