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
CoxHealth, Springfield, MO, USA.
Division of Pulmonary/Critical Care, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
SAGE Open Med. 2023 Jan 3;11:20503121221146907. doi: 10.1177/20503121221146907. eCollection 2023.
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.
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.
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%).
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.
目前脓毒症患者管理指南包括早期培养、抗生素给药和液体复苏。多项临床试验试图确定给予皮质类固醇是否能改善这些患者的预后。本研究分析了一大组重症患者的特征，这些患者要么在重症监护病房管理期间检测了皮质醇水平，要么在管理期间接受了氢化可的松治疗。
德克萨斯州拉伯克市大学医学中心的病历部门确定了一份接受皮质醇水平检测或经验性给予氢化可的松治疗脓毒症的患者名单。主要结局是住院死亡率。次要结局包括机械通气需求、肾脏替代治疗需求、血管升压药需求、住院时间以及医院感染的发生情况。
本研究纳入351例患者，其中194例为女性（55.3%）。平均年龄为62.9±16.1岁。平均入院序贯器官衰竭评估（SOFA）评分为9.3±3.63，平均急性生理与慢性健康状况评分系统Ⅱ（APACHE 2）评分为18.15±7.7，平均乳酸水平为3.8±4.0 mmol/L。162例患者需要插管，262例需要血管升压药，215例发生急性肾损伤，319例检测了皮质醇水平。平均住院时间为11.5±13.7天；死亡率为32.2%。多变量分析表明，较高的皮质醇水平与死亡率增加相关（皮质醇≥20μg/dL时死亡率为44.1%，而皮质醇<20μg/dL时为17.5%）。145例患者接受了皮质类固醇治疗，多变量分析表明这些患者死亡率增加（40.0%对26.7%）。
在本研究中，较高的皮质醇水平与死亡率增加相关。给予氢化可的松与死亡率增加相关，这可能反映了在预后较差可能性较高的患者中使用了这种药物。
