Comparative Effectiveness of Less vs. More Frequent Hydrocortisone Dosing in Septic Shock

Area of Science:

• Critical Care Medicine
• Pharmacology
• Intensive Care

Background:

• Hydrocortisone is recommended for septic shock, but optimal dosing remains unclear.
• A 2023 hydrocortisone shortage necessitated a change in dosing from 50 mg every 6 hours to 100 mg every 12 hours.
• This shift provided an opportunity to compare the effectiveness of these two hydrocortisone regimens.

Purpose of the Study:

• To compare the efficacy of two hydrocortisone dosing regimens in adult patients with septic shock.
• To evaluate the impact of dosing frequency on time to shock resolution, mortality, and renal replacement therapy.
• To assess medication costs and vasopressor requirements associated with different hydrocortisone regimens.

Main Methods:

• Single-center, retrospective cohort study involving adult patients in intensive care units (ICUs) with septic shock.
• Patients received either hydrocortisone 50 mg every 6 hours or 100 mg every 12 hours.
• Outcomes included time to shock resolution, mortality, need for renal replacement therapy (RRT), vasopressor dose, and medication costs.

Main Results:

• No significant difference was observed in time to shock resolution between the two hydrocortisone regimens (sub-hazard ratio [sub-HR] 0.95; 95% CI, 0.59-1.54).
• Neither ICU mortality (sub-HR 1.59; 95% CI, 0.89-2.84) nor in-hospital mortality (1.35; 95% CI, 0.81-2.26) differed significantly.
• The less frequent dosing regimen resulted in significant cost savings of $446.10 per patient.

Conclusions:

• A less frequent hydrocortisone dosing regimen (100 mg every 12 hours) is not associated with adverse effects on shock resolution time or mortality in septic shock.
• Further studies are needed to determine the comparative effectiveness of various corticosteroid dosing strategies in septic shock.
• The modified dosing regimen offers potential cost benefits without compromising patient outcomes.