Journal article
Characteristics and outcomes of patients with sepsis who had cortisol level measurements or received hydrocortisone during their intensive care unit management: A retrospective single center study
SAGE open medicine, Vol.11, pp.205031212211469-20503121221146907
01/01/2023
DOI: 10.1177/20503121221146907
PMCID: PMC9827519
PMID: 36632085
Abstract
Objectives:
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.
Methods:
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.
Results:
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%).
Conclusion:
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.
Details
- Title: Subtitle
- Characteristics and outcomes of patients with sepsis who had cortisol level measurements or received hydrocortisone during their intensive care unit management: A retrospective single center study
- Creators
- Marcella Rivas - CoxHealthArunee Motes - Texas Tech University Health Sciences CenterAmr Ismail - Texas Tech University Health Sciences CenterShengping Yang - Pennington Biomedical Research CenterDavid Sotello - CoxHealthMeily Arevalo - University of ArizonaWasawat Vutthikraivit - University of IowaSakolwan Suchartlikitwong - University of ArizonaCynthia Carrasco - Indiana University – Purdue University IndianapolisKenneth Iwuji - Texas Tech University Health Sciences CenterPavida Pachariyanon - Louisiana State University Health Sciences Center ShreveportSarah Jaroudi - Baylor College of MedicineSubhanudh Thavaraputta - UPMC Health SystemKenneth Nugent - Texas Tech University Health Sciences Center
- Resource Type
- Journal article
- Publication Details
- SAGE open medicine, Vol.11, pp.205031212211469-20503121221146907
- DOI
- 10.1177/20503121221146907
- PMID
- 36632085
- PMCID
- PMC9827519
- ISSN
- 2050-3121
- eISSN
- 2050-3121
- Language
- English
- Date published
- 01/01/2023
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984694746102771
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