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Association of mortality with fludrocortisone addition to hydrocortisone treatment among septic shock patients: a propensity score matching analysis

BACKGROUND: Several clinical trials of corticosteroids have been carried out in the treatment of septic shock, however, the therapeutic effect of the most widely used hydrocortisone is still controversial, and no studies have directly compared hydrocortisone versus hydrocortisone plus fludrocortison...

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Autores principales: Cheng, Xiaoxiao, Fu, Zhiqin, Liu, Yiting, Zheng, Xiaoyu, Hu, Tianyang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10203469/
https://www.ncbi.nlm.nih.gov/pubmed/37228404
http://dx.doi.org/10.3389/fmed.2023.1190758
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author Cheng, Xiaoxiao
Fu, Zhiqin
Liu, Yiting
Zheng, Xiaoyu
Hu, Tianyang
author_facet Cheng, Xiaoxiao
Fu, Zhiqin
Liu, Yiting
Zheng, Xiaoyu
Hu, Tianyang
author_sort Cheng, Xiaoxiao
collection PubMed
description BACKGROUND: Several clinical trials of corticosteroids have been carried out in the treatment of septic shock, however, the therapeutic effect of the most widely used hydrocortisone is still controversial, and no studies have directly compared hydrocortisone versus hydrocortisone plus fludrocortisone for patients with septic shock. METHODS: Baseline characteristics and treatment regimens of patients with septic shock treated with hydrocortisone from the Medical Information Mart for Intensive Care-IV database were collected. Patients were divided into hydrocortisone treatment groups and hydrocortisone plus fludrocortisone treatment groups. The primary outcome was 90-day mortality, and secondary outcomes included 28-day mortality, in-hospital mortality, length of hospital stay, and length of intensive care unit (ICU) stay. Binomial Logistic regression analysis was performed to identify independent risk factors for mortality. Survival analysis was performed and Kaplan–Meier curves were drawn for patients in different treatment groups. Propensity score matching (PSM) analysis was performed to reduce bias. RESULTS: Six hundred and fifty three patients were enrolled, of which 583 were treated with hydrocortisone alone, and 70 with hydrocortisone plus fludrocortisone. After PSM, 70 patients were included in each group. The proportion of patients with acute kidney injury (AKI) and the proportion of renal replacement therapy (RRT) treatment in the hydrocortisone plus fludrocortisone group were higher than those in the hydrocortisone alone group, and there was no significant difference in other baseline characteristics. Compared with hydrocortisone alone, hydrocortisone plus fludrocortisone did not reduce the 90-day mortality (after PSM, relative risk/RR = 1.07, 95%CI 0.75–1.51), 28-day mortality (after PSM, RR = 0.82, 95%CI 0.59–1.14) and in-hospital mortality (after PSM, RR = 0.79, 95%CI 0.57–1.11) of the enrolled patients, nor did it affect the length of hospital stay (after PSM, 13.9 days vs. 10.9 days, p = 0.34) and ICU stay (after PSM, 6.0 days vs. 3.7 days, p = 0.14), and the survival analysis showed no statistically significant difference in the corresponding survival time. After PSM, binomial Logistic regression analysis showed that SAPS II score was an independent risk factor for 28-day morality (OR = 1.04, 95%CI 1.02–1.06, p < 0.01) and in-hospital morality (OR = 1.04, 95%CI 1.01–1.06, p < 0.01), while hydrocortisone plus fludrocortisone was not an independent risk factor for 90-day mortality (OR = 0.88, 95%CI 0.43–1.79, p = 0.72), 28-day morality (OR = 1.50, 95%CI 0.77–2.91, p = 0.24), or in-hospital morality (OR = 1.58, 95%CI 0.81–3.09, p = 0.18). CONCLUSION: In the treatment of patients with septic shock, hydrocortisone plus fludrocortisone did not reduce 90-day mortality, 28-day mortality, and in-hospital mortality compared with hydrocortisone alone, and had no effect on the length of hospital stay and ICU stay.
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spelling pubmed-102034692023-05-24 Association of mortality with fludrocortisone addition to hydrocortisone treatment among septic shock patients: a propensity score matching analysis Cheng, Xiaoxiao Fu, Zhiqin Liu, Yiting Zheng, Xiaoyu Hu, Tianyang Front Med (Lausanne) Medicine BACKGROUND: Several clinical trials of corticosteroids have been carried out in the treatment of septic shock, however, the therapeutic effect of the most widely used hydrocortisone is still controversial, and no studies have directly compared hydrocortisone versus hydrocortisone plus fludrocortisone for patients with septic shock. METHODS: Baseline characteristics and treatment regimens of patients with septic shock treated with hydrocortisone from the Medical Information Mart for Intensive Care-IV database were collected. Patients were divided into hydrocortisone treatment groups and hydrocortisone plus fludrocortisone treatment groups. The primary outcome was 90-day mortality, and secondary outcomes included 28-day mortality, in-hospital mortality, length of hospital stay, and length of intensive care unit (ICU) stay. Binomial Logistic regression analysis was performed to identify independent risk factors for mortality. Survival analysis was performed and Kaplan–Meier curves were drawn for patients in different treatment groups. Propensity score matching (PSM) analysis was performed to reduce bias. RESULTS: Six hundred and fifty three patients were enrolled, of which 583 were treated with hydrocortisone alone, and 70 with hydrocortisone plus fludrocortisone. After PSM, 70 patients were included in each group. The proportion of patients with acute kidney injury (AKI) and the proportion of renal replacement therapy (RRT) treatment in the hydrocortisone plus fludrocortisone group were higher than those in the hydrocortisone alone group, and there was no significant difference in other baseline characteristics. Compared with hydrocortisone alone, hydrocortisone plus fludrocortisone did not reduce the 90-day mortality (after PSM, relative risk/RR = 1.07, 95%CI 0.75–1.51), 28-day mortality (after PSM, RR = 0.82, 95%CI 0.59–1.14) and in-hospital mortality (after PSM, RR = 0.79, 95%CI 0.57–1.11) of the enrolled patients, nor did it affect the length of hospital stay (after PSM, 13.9 days vs. 10.9 days, p = 0.34) and ICU stay (after PSM, 6.0 days vs. 3.7 days, p = 0.14), and the survival analysis showed no statistically significant difference in the corresponding survival time. After PSM, binomial Logistic regression analysis showed that SAPS II score was an independent risk factor for 28-day morality (OR = 1.04, 95%CI 1.02–1.06, p < 0.01) and in-hospital morality (OR = 1.04, 95%CI 1.01–1.06, p < 0.01), while hydrocortisone plus fludrocortisone was not an independent risk factor for 90-day mortality (OR = 0.88, 95%CI 0.43–1.79, p = 0.72), 28-day morality (OR = 1.50, 95%CI 0.77–2.91, p = 0.24), or in-hospital morality (OR = 1.58, 95%CI 0.81–3.09, p = 0.18). CONCLUSION: In the treatment of patients with septic shock, hydrocortisone plus fludrocortisone did not reduce 90-day mortality, 28-day mortality, and in-hospital mortality compared with hydrocortisone alone, and had no effect on the length of hospital stay and ICU stay. Frontiers Media S.A. 2023-05-09 /pmc/articles/PMC10203469/ /pubmed/37228404 http://dx.doi.org/10.3389/fmed.2023.1190758 Text en Copyright © 2023 Cheng, Fu, Liu, Zheng and Hu. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Cheng, Xiaoxiao
Fu, Zhiqin
Liu, Yiting
Zheng, Xiaoyu
Hu, Tianyang
Association of mortality with fludrocortisone addition to hydrocortisone treatment among septic shock patients: a propensity score matching analysis
title Association of mortality with fludrocortisone addition to hydrocortisone treatment among septic shock patients: a propensity score matching analysis
title_full Association of mortality with fludrocortisone addition to hydrocortisone treatment among septic shock patients: a propensity score matching analysis
title_fullStr Association of mortality with fludrocortisone addition to hydrocortisone treatment among septic shock patients: a propensity score matching analysis
title_full_unstemmed Association of mortality with fludrocortisone addition to hydrocortisone treatment among septic shock patients: a propensity score matching analysis
title_short Association of mortality with fludrocortisone addition to hydrocortisone treatment among septic shock patients: a propensity score matching analysis
title_sort association of mortality with fludrocortisone addition to hydrocortisone treatment among septic shock patients: a propensity score matching analysis
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10203469/
https://www.ncbi.nlm.nih.gov/pubmed/37228404
http://dx.doi.org/10.3389/fmed.2023.1190758
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