(1487) Taper Versus Non-Taper Discontinuation Strategy of Hydrocortisone in Septic Shock

Introduction: The optimal strategy for steroid discontinuation after septic shock resolution is unknown. Landmark studies evaluating the role of hydrocortisone in septic shock differed in method of steroid discontinuation. Scant data exists evaluating the impact of specific steroid discontinuation strategies after shock resolution. Steroid tapering leads to a longer exposure to steroids and an increased risk of steroid-induced adverse events. Abrupt discontinuation of steroids may lead to recurrent hypotension and a need for vasopressor re-initiation. The goal of this study is to describe the outcomes of different steroid discontinuation practices in patients with septic shock.

Methods: A retrospective analysis of patients with septic shock who received vasopressors and an initial total daily dose of 200 to 300 mg of hydrocortisone from May 1, 2021 until April 30, 2023 was performed. The primary outcome was the incidence of hemodynamic instability, which was defined as a mean arterial pressure ≤ 65 mm Hg, requiring the re-initiation of vasopressors, or requiring a fluid bolus within 24 hours of the last steroid dose or during the taper period. Secondary outcomes included ICU length of stay and proportion of patients with at least two episodes of hyperglycemia (i.e., blood glucose ≥ 180 mg/dL) during and 24 hours post hydrocortisone.

Results: A total of 410 patients were identified for review of which 60 were included. The taper group included 42 patients and the remaining 18 patients were included in the abrupt cessation group. There was no statistically significant difference in hemodynamic instability between the taper group compared to the non-taper group (35% vs. 12.5%, p =0.308). There were longer hospital lengths of stay (27.5 days vs 12.6 days, p < 0.001) and ICU lengths of stay (8.7 days vs 4.9 days, p =0.030) in the taper group compared to the non-taper group. There was no difference in the number of patients that experienced hyperglycemia through 24 hours post hydrocortisone discontinuation between the taper and non-taper group (42.9% vs. 55.5%, p=0.408).

Conclusions: The abrupt withdrawal of hydrocortisone after the resolution of septic shock did not impact hemodynamic stability among this patient population and may be associated with decreased medication burden and adverse events.