Τίτλος:
Early Administration of Hydrocortisone Replacement After the Advent of
Septic Shock: Impact on Survival and Immune Response
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Objectives: To investigate the impact of early initiation of
hydrocortisone therapy on the clinical course of septic shock and on
cytokine release.
Design: Prospective study in patients with septic shock treated with low
doses of hydrocortisone.
Setting: ICUs and general wards.
Patients: Over a 2-year period, 170 patients with septic shock treated
with low doses of hydrocortisone were enrolled. Blood was sampled from
34 patients for isolation of peripheral blood mononuclear cells and
cytokine stimulation before and 24 hours after the start of
hydrocortisone.
Interventions: None.
Measurements and Main Results: After quartile analysis, patients were
divided into those with early initiation of hydrocortisone (< 9 hr after
vasopressors, n = 46) and those with late initiation of hydrocortisone
(> 9 hr after vasopressors, n = 124). After adjusting for disease
severity and type of infection, a protective effect of early
hydrocortisone administration against unfavorable outcome was found
(hazard ratio, 0.20; p = 0.012). Time of discontinuation of vasopressors
was earlier among patients with initiation of hydrocortisone within 9
hours. Production of tumor necrosis factor- was lower among patients who
had had hydrocortisone early.
Conclusions: In patients receiving hydrocortisone for septic shock,
early initiation of treatment was associated with improved survival.
This treatment was also associated with attenuated stimulation of tumor
necrosis factor-.
Συγγραφείς:
Katsenos, Chrysostomos S.
Antonopoulou, Anastasia N. and
Apostolidou, Efterpi N.
Ioakeimidou, Aikaterini
Kalpakou,
Georgia Th.
Papanikolaou, Metaxia N.
Pistiki, Aikaterini C. and
Mpalla, Margarita C.
Paraschos, Michael D.
Patrani, Maria A. and
Pratikaki, Maria E.
Retsas, Theodoros A.
Savva, Athina A. and
Vassiliagkou, Spyridoula D.
Lekkou, Alexandra A.
Dimopoulou,
Ioanna
Routsi, Christina
Mandragos, Konstantinos E.
Hellenic
Sepsis Study Grp
Περιοδικό:
Pediatric Critical Care Medicine
Εκδότης:
Lippincott, Williams & Wilkins
Λέξεις-κλειδιά:
critical illness; critical illness-related corticosteroid insufficiency;
hydrocortisone; outcome; relative adrenal insufficiency; sepsis; septic
shock; steroid replacement; tumor necrosis factor-alpha
DOI:
10.1097/CCM.0000000000000318
