TY - JOUR
TI - Exposure to Stress-Dose Steroids and Lethal Septic Shock After
In-Hospital Cardiac Arrest: Individual Patient Data Reanalysis of Two
Prior Randomized Clinical Trials that Evaluated the
Vasopressin-Steroids-Epinephrine Combination Versus Epinephrine Alone
AU - Mentzelopoulos, Spyros D.
AU - Koliantzaki, Iosifina
AU - Karvouniaris,
AU - Marios
AU - Vrettou, Charikleia
AU - Mongardon, Nicolas
AU - Karlis, George
AU - and Makris, Demosthenes
AU - Zakynthinos, Epaminondas
AU - Sourlas,
AU - Sotirios
AU - Aloizos, Stavros
AU - Xanthos, Theodoros
AU - Zakynthinos,
AU - Spyros G.
JO - Cardiovascular Drugs and Therapy
PY - 2018
VL - 32
TODO - 4
SP - 339-351
PB - Springer-Verlag
SN - 0920-3206, 1573-7241
TODO - 10.1007/s10557-018-6811-0
TODO - Steroids; Shock; Septic; Heart arrest; Vasopressins
TODO - Low-dose steroids may reduce the mortality of severely ill patients with
septic shock. We sought to determine whether exposure to stress-dose
steroids during and/or after cardiopulmonary resuscitation is associated
with reduced risk of death due to postresuscitation septic shock.
We analyzed pooled, individual patient data from two prior, randomized
clinical trials (RCTs). RCTs evaluated vasopressin, steroids, and
epinephrine (VSE) during resuscitation and stress-dose steroids after
resuscitation in vasopressor-requiring, in-hospital cardiac arrest. In
the second RCT, 15 control group patients received open-label,
stress-dose steroids. Patients with postresuscitation shock were
assigned to a Steroids (n = 118) or No Steroids (n = 73) group according
to an “as-treated” principle. We used cumulative incidence competing
risks Cox regression to determine cause-specific hazard ratios (CSHRs)
for pre-specified predictors of lethal septic shock (primary outcome).
In sensitivity analyses, data were analyzed according to the
intention-to-treat (ITT) principle (VSE group, n = 103; control group, n
= 88).
Lethal septic shock was less likely in Steroids versus No Steroids
group, CSHR, 0.40, 95% confidence interval (CI), 0.20-0.82; p = 0.012.
ITT analysis yielded similar results: VSE versus Control, CSHR, 0.44,
95% CI, 0.23-0.87; p = 0.019. Adjustment for significant, between-group
baseline differences in composite cardiac arrest causes such as
“hypotension and/or myocardial ischemia” did not appreciably affect
the aforementioned CSHRs.
In this reanalysis, exposure to stress-dose steroids (primarily in the
context of a combined VSE intervention) was associated with lower risk
of postresuscitation lethal septic shock.
ER -