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Characteristics and outcomes of patients with sepsis who had cortisol level measurements or received hydrocortisone during their intensive care unit management: A retrospective single center study

OBJECTIVES: The current guidelines for managing patients with sepsis include the early cultures, administration of antibiotics, and fluid resuscitation. Several clinical trials have tried to determine whether or not the administration of corticosteroids improves outcomes in these patients. This stud...

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Autores principales: Rivas, Marcella, Motes, Arunee, Ismail, Amr, Yang, Shengping, Sotello, David, Arevalo, Meily, Vutthikraivit, Wasawat, Suchartlikitwong, Sakolwan, Carrasco, Cynthia, Iwuji, Kenneth, Pachariyanon, Pavida, Jaroudi, Sarah, Thavaraputta, Subhanudh, Nugent, Kenneth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9827519/
https://www.ncbi.nlm.nih.gov/pubmed/36632085
http://dx.doi.org/10.1177/20503121221146907
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author Rivas, Marcella
Motes, Arunee
Ismail, Amr
Yang, Shengping
Sotello, David
Arevalo, Meily
Vutthikraivit, Wasawat
Suchartlikitwong, Sakolwan
Carrasco, Cynthia
Iwuji, Kenneth
Pachariyanon, Pavida
Jaroudi, Sarah
Thavaraputta, Subhanudh
Nugent, Kenneth
author_facet Rivas, Marcella
Motes, Arunee
Ismail, Amr
Yang, Shengping
Sotello, David
Arevalo, Meily
Vutthikraivit, Wasawat
Suchartlikitwong, Sakolwan
Carrasco, Cynthia
Iwuji, Kenneth
Pachariyanon, Pavida
Jaroudi, Sarah
Thavaraputta, Subhanudh
Nugent, Kenneth
author_sort Rivas, Marcella
collection PubMed
description OBJECTIVES: The current guidelines for managing patients with sepsis include the early cultures, administration of antibiotics, and fluid resuscitation. Several clinical trials have tried to determine whether or not the administration of corticosteroids improves outcomes in these patients. This study analyzed the characteristics of a large group of critically ill patients who either had cortisol levels drawn during their intensive care unit management or had hydrocortisone administered during their management. METHODS: A list of patients who had cortisol levels measured or who had hydrocortisone administered empirically for the treatment of sepsis was identified by the medical record department at University Medical Center in Lubbock, Texas. The primary outcome was in-hospital mortality. Secondary outcomes included the need for mechanical ventilation, the need for renal replacement therapy, the need for vasopressors, length of stay, and the development of nosocomial infections. RESULTS: This study included 351 patients, including 194 women (55.3%). The mean age was 62.9 ± 16.1 years. The mean admission SOFA score was 9.3 ± 3.63, the mean APACHE 2 score was 18.15 ± 7.7, and the mean lactic acid level was 3.8 ± 4.0 mmol/L. One hundred sixty-two patients required intubation, 262 required vasopressors, 215 developed acute kidney injury, and 319 had cortisol levels measured. The mean length of stay was 11.5 ± 13.7 days; the mortality rate was 32.2%. Multiple variable analysis demonstrated that higher cortisol levels were associated with increased mortality (44.1% if cortisol ⩾20 µg/dL versus 17.5% if cortisol <20 µg/dL). One hundred forty-five patients received corticosteroids, and multivariable analysis demonstrated that these patients had increased mortality (40.0% versus 26.7%). CONCLUSION: In this study, higher cortisol levels were associated with increased mortality. The administration of hydrocortisone was associated with increased mortality possibly reflecting the use of this medication in patients who had a higher likelihood of poor outcomes.
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spelling pubmed-98275192023-01-10 Characteristics and outcomes of patients with sepsis who had cortisol level measurements or received hydrocortisone during their intensive care unit management: A retrospective single center study Rivas, Marcella Motes, Arunee Ismail, Amr Yang, Shengping Sotello, David Arevalo, Meily Vutthikraivit, Wasawat Suchartlikitwong, Sakolwan Carrasco, Cynthia Iwuji, Kenneth Pachariyanon, Pavida Jaroudi, Sarah Thavaraputta, Subhanudh Nugent, Kenneth SAGE Open Med Original Article OBJECTIVES: The current guidelines for managing patients with sepsis include the early cultures, administration of antibiotics, and fluid resuscitation. Several clinical trials have tried to determine whether or not the administration of corticosteroids improves outcomes in these patients. This study analyzed the characteristics of a large group of critically ill patients who either had cortisol levels drawn during their intensive care unit management or had hydrocortisone administered during their management. METHODS: A list of patients who had cortisol levels measured or who had hydrocortisone administered empirically for the treatment of sepsis was identified by the medical record department at University Medical Center in Lubbock, Texas. The primary outcome was in-hospital mortality. Secondary outcomes included the need for mechanical ventilation, the need for renal replacement therapy, the need for vasopressors, length of stay, and the development of nosocomial infections. RESULTS: This study included 351 patients, including 194 women (55.3%). The mean age was 62.9 ± 16.1 years. The mean admission SOFA score was 9.3 ± 3.63, the mean APACHE 2 score was 18.15 ± 7.7, and the mean lactic acid level was 3.8 ± 4.0 mmol/L. One hundred sixty-two patients required intubation, 262 required vasopressors, 215 developed acute kidney injury, and 319 had cortisol levels measured. The mean length of stay was 11.5 ± 13.7 days; the mortality rate was 32.2%. Multiple variable analysis demonstrated that higher cortisol levels were associated with increased mortality (44.1% if cortisol ⩾20 µg/dL versus 17.5% if cortisol <20 µg/dL). One hundred forty-five patients received corticosteroids, and multivariable analysis demonstrated that these patients had increased mortality (40.0% versus 26.7%). CONCLUSION: In this study, higher cortisol levels were associated with increased mortality. The administration of hydrocortisone was associated with increased mortality possibly reflecting the use of this medication in patients who had a higher likelihood of poor outcomes. SAGE Publications 2023-01-03 /pmc/articles/PMC9827519/ /pubmed/36632085 http://dx.doi.org/10.1177/20503121221146907 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Article
Rivas, Marcella
Motes, Arunee
Ismail, Amr
Yang, Shengping
Sotello, David
Arevalo, Meily
Vutthikraivit, Wasawat
Suchartlikitwong, Sakolwan
Carrasco, Cynthia
Iwuji, Kenneth
Pachariyanon, Pavida
Jaroudi, Sarah
Thavaraputta, Subhanudh
Nugent, Kenneth
Characteristics and outcomes of patients with sepsis who had cortisol level measurements or received hydrocortisone during their intensive care unit management: A retrospective single center study
title Characteristics and outcomes of patients with sepsis who had cortisol level measurements or received hydrocortisone during their intensive care unit management: A retrospective single center study
title_full Characteristics and outcomes of patients with sepsis who had cortisol level measurements or received hydrocortisone during their intensive care unit management: A retrospective single center study
title_fullStr Characteristics and outcomes of patients with sepsis who had cortisol level measurements or received hydrocortisone during their intensive care unit management: A retrospective single center study
title_full_unstemmed Characteristics and outcomes of patients with sepsis who had cortisol level measurements or received hydrocortisone during their intensive care unit management: A retrospective single center study
title_short Characteristics and outcomes of patients with sepsis who had cortisol level measurements or received hydrocortisone during their intensive care unit management: A retrospective single center study
title_sort characteristics and outcomes of patients with sepsis who had cortisol level measurements or received hydrocortisone during their intensive care unit management: a retrospective single center study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9827519/
https://www.ncbi.nlm.nih.gov/pubmed/36632085
http://dx.doi.org/10.1177/20503121221146907
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