(1431) Timing of Stress-Dose Steroid Initiation in Adult Patients With Septic Shock

Introduction: Sepsis is a life-threatening condition which requires immediate treatment to reduce mortality. The mainstay of treatment for decades has revolved around fluid resuscitation, antimicrobial agents, and vasopressor support. Recent evidence has suggested that corticosteroids may reduce the need for vasopressors, which is reflected in the 2021 surviving sepsis guidelines. However, the recommendation only states that IV corticosteroids should be used, and is rated as weak with moderate quality of evidence. Currently, there is minimal guidance regarding the timing of steroid initiation.

Methods: Retrospective cohort study conducted across a multi-center community health system between January 2021 to August 2022. Patients were included if they were > 18 years old admitted to an ICU, were diagnosed with septic shock, and had received at least 12 hours of stress-dose hydrocortisone. Patients were divided into two groups based on when vasopressors were initiated: Early initiation (within 12 hours) and late initiation (12 hours or more). The groups were matched to each other in a 1:1 ratio to adjust for differences in baseline demographics.

Results: A total of 110 patients were included in the final analysis. Patients in the early group required significantly fewer days of vasopressors compared to the late group (p = 0.001). Additionally, patients in the early group were less likely to require mechanical ventilation (42.9% and 61.7%, respectively; p = 0.05) and vasopressors (25.4 and 48.9, respectively; p = 0.01) at the time of steroid initiation. All-cause mortality and ICU mortality at day 28 significantly improved in the early group (p < 0.05). It was also identified that patients in the early group had significantly greater resolution of septic shock compared to the late group (p < 0.001).

Conclusions: Early initiation of stress-dose hydrocortisone was associated with significant improvement in ventilation and vasopressor requirements, length of vasopressor therapy, mortality, and resolution of septic shock compared to late initiation. However, the time to septic shock resolution was not significantly different between the two groups.