Low-dose steroids in adult septic shock: results of the Surviving Sepsis Campaign
Low-dose steroids in adult septic shock: results of the Surviving Sepsis Campaign
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DOI：
10.1007/s00134-012-2720-z
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发表时间：
2012-12-01
影响因子：
38.9
通讯作者：
Levy, Mitchell M.
中科院分区：
文献类型：
--
作者：
Casserly, Brian;Gerlach, Herwig;Levy, Mitchell M.
脓毒症生存运动（SSC）制定了成人脓毒症休克中类固醇给药的指南和治疗包。然而，目前尚不清楚这是如何影响临床实践或患者结局的，SSC已经开发了一个广泛的数据库，以评估其指南对临床实践和患者结局的总体影响。本分析侧重于SSC管理包的一个特定元素，即在成人感染性休克中给予低剂量类固醇。该分析基于2005年1月至2010年3月提交的数据，包括218个研究中心的27，836例受试者。数据库中共有17，847例（共27，836例）患者需要血管加压治疗，尽管进行了液体复苏，因此符合接受低剂量类固醇的合格标准。共有8，992例患者（50.4%）因感染性休克接受低剂量类固醇治疗。欧洲（59.4%）和南美洲（51.9%）的患者与北美（46.2%，p < 0.001）的患者相比更有可能接受低剂量类固醇。与未接受低剂量类固醇的患者相比，接受低剂量类固醇的患者的校正住院死亡率显著较高（OR 1.18，95% CI 1.09-1.23，p < 0.001）。即使在8小时内开药，低剂量类固醇仍与调整后的住院死亡率增加相关（OR 1.23，95% CI 1.13-1.34，p < 0.001）。然而，这与调整后的住院死亡率增加有关。
The Surviving Sepsis Campaign (SSC) developed guidelines and treatment bundles for the administration of steroids in adult septic shock. However, it is not clear how this has affected clinical practice or patient outcome.The SSC has developed an extensive database to assess the overall effect of its guidelines on clinical practice and patient outcome. This analysis focuses on one particular element of the SSC's management bundle, namely, the administration of low-dose steroids in adult septic shock. This analysis was conducted on data submitted from January 2005 through March 2010 including 27,836 subjects at 218 sites.A total of 17,847 (of the total 27,836) patients in the database required vasopressor therapy despite fluid resuscitation and therefore met the eligibility criteria for receiving low-dose steroids. A total of 8,992 patients (50.4 %) received low-dose steroids for their septic shock. Patients in Europe (59.4 %) and South America (51.9 %) were more likely to be prescribed low-dose steroids compared to their counterparts in North America (46.2 %, p < 0.001). The adjusted hospital mortality was significantly higher (OR 1.18, 95 % CI 1.09-1.23, p < 0.001) in patients who received low-dose steroids compared to those who did not. There was still an association with increased adjusted hospital mortality with low-dose steroids even if they were prescribed within 8 h (OR 1.23, 95 % CI 1.13-1.34, p < 0.001).Steroids were commonly administered in the treatment of septic shock in this subset analysis of the Surviving Sepsis Campaign database. However, this was associated with an increase in adjusted hospital mortality.