John Kayla E, Kirkpatrick Megan M, Aytoda Priyanka H, Elefritz Jessica L, Palettas Marilly, Rosales Brittany N, Murphy Claire V, Doepker Bruce A
Department of Pharmacy, The University of North Carolina at Chapel Hill Medical Center, Chapel Hill, NC, USA.
Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Int J Crit Illn Inj Sci. 2024 Apr-Jun;14(2):79-85. doi: 10.4103/ijciis.ijciis_66_23. Epub 2024 Jun 21.
The 2021 Surviving Sepsis Campaign Guidelines recommend the use of hydrocortisone in patients who remain hemodynamically unstable despite adequate fluid resuscitation and vasopressor therapy. Fludrocortisone has been used concomitantly with hydrocortisone in some studies without a clearly defined role or known clinical benefit. The purpose of this study was to assess the impact of fludrocortisone added to hydrocortisone on shock-free days for septic shock.
A single-center, retrospective propensity score-weighted study was conducted to compare hydrocortisone versus hydrocortisone plus fludrocortisone for septic shock. Adults admitted to the medical intensive care unit (ICU) from 2015 to 2020 were included in the study. All patients received ≥200 mg/day hydrocortisone for at least 24 h ± fludrocortisone initiated within 72 h of vasopressors. The primary outcome was shock-free days by day 14. The secondary outcomes included duration of shock, change in Sequential Organ Failure Assessment (SOFA) score, hospital and ICU length of stay, and all-cause inhospital mortality.
A total of 228 patients met inclusion criteria with 212 patients retained after propensity score weighting. There was no difference between groups in 14-day shock-free days (6.3 vs. 6.1 days; = 0.781). Furthermore, no significant differences were observed for the secondary outcomes of ICU/hospital length of stay, duration of shock, change in SOFA score, and all-cause inhospital mortality.
The addition of fludrocortisone to hydrocortisone in septic shock did not increase shock-free days by day 14. These results suggest that the use of hydrocortisone alone may be an adequate adjunctive therapy in septic shock. A prospective randomized controlled trial is needed to confirm results.
2021年拯救脓毒症运动指南建议，对于经充分液体复苏和血管活性药物治疗后仍存在血流动力学不稳定的患者，使用氢化可的松。在一些研究中，氟氢可的松与氢化可的松联合使用，但作用未明确界定，临床获益也未知。本研究的目的是评估在氢化可的松基础上加用氟氢可的松对感染性休克无休克天数的影响。
进行了一项单中心、回顾性倾向评分加权研究，比较氢化可的松与氢化可的松加氟氢可的松治疗感染性休克的效果。纳入2015年至2020年入住内科重症监护病房（ICU）的成年患者。所有患者接受≥200mg/天氢化可的松治疗至少24小时，并在血管活性药物使用72小时内加用或不加用氟氢可的松。主要结局是第14天的无休克天数。次要结局包括休克持续时间、序贯器官衰竭评估（SOFA）评分变化、住院和ICU住院时间以及全因住院死亡率。
共有228例患者符合纳入标准，倾向评分加权后保留212例患者。两组在14天无休克天数方面无差异（6.3天对6.1天；P = 0.781）。此外，在ICU/住院时间、休克持续时间、SOFA评分变化和全因住院死亡率等次要结局方面未观察到显著差异。
感染性休克患者在氢化可的松基础上加用氟氢可的松并未增加第14天的无休克天数。这些结果表明，单独使用氢化可的松可能是感染性休克的一种充分的辅助治疗方法。需要进行前瞻性随机对照试验来证实结果。
