Hydrocortisone does not affect time to shock reversal in cancer patients with septic shock

Use of hydrocortisone relative to methylprednisolone appears to have no impact on time to shock reversal in cancer patients with septic shock, results of a study have shown.

The authors sought to compare the effect of hydrocortisone ≥200 mg/day versus methylprednisolone ≥40 mg/day on duration of septic shock in critically ill oncology patients in this single-centre, retrospective study. Time to shock reversal, the primary outcome, was defined as time to systolic blood pressure ≥90 mm Hg without vasopressors for ≥24 h.

Of the 88 patients included, 49 received hydrocortisone and 39 methylprednisolone. More patients in the hydrocortisone group had solid tumour malignancy, while haematological malignancy occurred more frequently in the methylprednisolone group (p=0.009).

Time to shock reversal was comparable between the two treatment groups (72.4 vs 70.4 h; p=0.825). Intensive care unit (ICU) mortality occurred in 51.02 percent of patients in the hydrocortisone group and 53.85 percent of those in the methylprednisolone group (p=0.792).

Patients who received methylprednisolone had higher rates of mechanical ventilation (89.74 precent vs 55.1 percent; p<0.001) and longer ICU (4.2 vs 11.4 days) and hospital lengths of stay (14.3 vs 25.7 days; p<0.001) compared with those on hydrocortisone.

There were no differences in the incidence of steroid-related adverse effects between the two groups.

“Corticosteroids are used as adjunctive treatment of critical illness-related corticosteroid insufficiency in patients with septic shock,” the authors said.