Banner University Medical Center-Tucson, Tucson, AZ, USA.
Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ, USA.
Am J Health Syst Pharm. 2022 Aug 19;79(Suppl 3):S94-S99. doi: 10.1093/ajhp/zxac156.
Several studies have shown hydrocortisone to be beneficial in the treatment of vasopressor-refractory septic shock, but there are minimal data evaluating the efficacy of this fixed dosing regimen in overweight and obese patients. The purpose of this study was to compare the effects of fixed-dose hydrocortisone on vasopressor dose and mean arterial pressure in obese and nonobese patients with septic shock refractory to adequate fluid resuscitation and vasopressor administration.
In this multicenter, retrospective study, we included adult patients with a confirmed or suspected diagnosis of septic shock who received hydrocortisone (200 mg/day). Patients were divided into 4 study groups based on admission body mass index (BMI; defined as BMI of <25 kg/m2, 25-29.9 kg/m2, 30-34.9 kg/m2, and ≥35 kg/m2). The primary outcomes analyzed were change in norepinephrine equivalent dose requirements and mean arterial pressure (MAP) at 6, 12, and 24 hours after initiating hydrocortisone.
Between October 1, 2017, and September 30, 2020, 431 patients were screened of whom 219 met inclusion criteria. Baseline characteristics were comparable among the groups. Mean vasopressor requirements (in μg/min) at 6, 12, and 24 hours were as follows: BMI of <25 kg/m2: 28.8, 24.8, and 20; BMI of 25-29.9 kg/m2: 34.1, 33.5, and 24.8; BMI of 30-34.9 kg/m2: 29.5, 33.5, and 24.8; and BMI of ≥35 kg/m2: 32, 25.7 and, 21.2 (P = 0.75, 0.41, and 0.61, respectively). Mean MAP (in mm Hg) at 6, 12, and 24 hours was as follows: BMI of <25 kg/m2: 73.5, 73.6, and 74; BMI of 25-29.9 kg/m2: 71.6, 73.8, and 71.9; BMI of 30-34.9 kg/m2: 72.2, 70, and 72.7; and BMI of ≥35 kg/m2: 70.7, 73.5, and 71.4 (P = 0.56, 0.15, and 0.62, respectively).
BMI does not appear to impact the effects of fixed-dose hydrocortisone on vasopressor dose or blood pressure in patients with septic shock. Fixed-dose hydrocortisone should continue to be used for vasopressor-refractory septic shock in obese patients.
几项研究表明，氢化可的松在治疗升压药抵抗性脓毒性休克方面是有益的，但评估超重和肥胖患者中这种固定剂量方案疗效的数据很少。本研究的目的是比较固定剂量氢化可的松对接受充分液体复苏和升压药治疗后仍发生升压药抵抗性脓毒性休克的肥胖和非肥胖患者的升压药剂量和平均动脉压的影响。
在这项多中心回顾性研究中，我们纳入了接受氢化可的松（200mg/天）治疗的确诊或疑似脓毒性休克的成年患者。患者根据入院时的体重指数（BMI；定义为<25kg/m2、25-29.9kg/m2、30-34.9kg/m2 和≥35kg/m2）分为 4 个研究组。分析的主要结局为开始使用氢化可的松后 6、12 和 24 小时去甲肾上腺素等效剂量需求和平均动脉压（MAP）的变化。
在 2017 年 10 月 1 日至 2020 年 9 月 30 日期间，对 431 名患者进行了筛选，其中 219 名符合纳入标准。组间基线特征无差异。6、12 和 24 小时的平均升压药需求（μg/min）如下：BMI<25kg/m2：28.8、24.8 和 20；BMI 为 25-29.9kg/m2：34.1、33.5 和 24.8；BMI 为 30-34.9kg/m2：29.5、33.5 和 24.8；BMI≥35kg/m2：32、25.7 和 21.2（P=0.75、0.41 和 0.61）。6、12 和 24 小时的平均 MAP（mmHg）如下：BMI<25kg/m2：73.5、73.6 和 74；BMI 为 25-29.9kg/m2：71.6、73.8 和 71.9；BMI 为 30-34.9kg/m2：72.2、70 和 72.7；BMI 为≥35kg/m2：70.7、73.5 和 71.4（P=0.56、0.15 和 0.62）。
BMI 似乎不会影响固定剂量氢化可的松对脓毒性休克患者升压药剂量或血压的影响。在肥胖患者中，固定剂量氢化可的松应继续用于升压药抵抗性脓毒性休克。
