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Association Between Different Glucocorticoids and Mortality in ICU Patients With Sepsis-Related Acute Respiratory
Jiayang Huang1, Zhikun Xu1, Jiajia Huang1
1Department of Critical Care Medicine, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.
Background:
The comparative effectiveness of specific glucocorticoids (methylprednisolone, hydrocortisone, and dexamethasone) and the impact of dosing intensity on outcomes in sepsis-associated acute respiratory distress syndrome (ARDS) remain poorly characterized.
Methods:
This retrospective cohort study analyzed adults with sepsis-associated ARDS from the Medical Information Mart for Intensive Care IV database. Patients were classified by glucocorticoid type and dose (low-dose: <88 mg/day methylprednisolone equivalent; high-dose: ≥88 mg/day). The primary outcome was 28-day mortality, analyzed using multivariable Cox models with hazard ratio (HR) and 95% confidence interval (CI). Subgroup analyses and propensity score matching (PSM) were performed to validate the findings.
Results:
Among 896 patients, 443 (49.4%) died within 28 days. Compared with hydrocortisone, both methylprednisolone (adjusted HR = 0.71, 95% CI 0.57-0.89) and dexamethasone (adjusted HR = 0.61, 95% CI 0.44-0.86) were associated with lower 28-day mortality. High-dose therapy was associated with increased mortality versus low-dose (adjusted HR = 1.56, 95% CI 1.23-1.97). Results were consistent across subgroups and in PSM analyses.
Conclusion:
In sepsis-associated ARDS, glucocorticoid selection and dose are associated with survival. Methylprednisolone and dexamethasone were associated with lower mortality compared with hydrocortisone, while high-dose therapy was linked to increased mortality.
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