Journal article
The Association of Early Corticosteroid Therapy With Clinical and Health-Related Quality of Life Outcomes in Children With Septic Shock
Pediatric critical care medicine, Vol.23(9), pp.687-697
09/01/2022
DOI: 10.1097/PCC.0000000000003009
PMCID: PMC9444900
PMID: 35695852
Abstract
OBJECTIVES: Corticosteroids are commonly used in the treatment of pediatric septic shock without clear evidence of the potential benefits or risks. This study examined the association of early corticosteroid therapy with patient-centered clinically meaningful outcomes. DESIGN: Subsequent cohort analysis of data derived from the prospective Life After Pediatric Sepsis Evaluation (LAPSE) investigation. Outcomes among patients receiving hydrocortisone or methylprednisolone on study day 0 or 1 were compared with those who did not use a propensity score-weighted analysis that controlled for age, sex, study site, and measures of first-day illness severity. SETTING: Twelve academic PICUs in the United States. PATIENTS: Children with community-acquired septic shock 1 month to 18 years old enrolled in LAPSE, 2013-2017. Exclusion criteria included a history of chronic corticosteroid administration. INTERVENTIONS: None. MEASUREMENTS and MAIN RESULTS: Among children enrolled in LAPSE, 352 of 392 met analysis inclusion criteria, and 155 of 352 (44%) received early corticosteroid therapy. After weighting corticosteroid therapy administration propensity across potentially confounding baseline characteristics, differences in outcomes associated with treatment were not statistically significant (adjusted effect or odds ratio [95% CI]): vasoactive-inotropic support duration (-0.37 d [-1.47 to 0.72]; p = 0.503), short-term survival without new morbidity (1.37 [0.83-2.28]; p = 0.218), new morbidity among month-1 survivors (0.70 [0.39-1.23]; p = 0.218), and persistent severe deterioration of health-related quality of life or mortality at month 1 (0.70 [0.40-1.23]; p = 0.212). CONCLUSIONS: This study examined the association of early corticosteroid therapy with mortality and morbidity among children encountering septic shock. After adjusting for variables with the potential to confound the relationship between early corticosteroid administration and clinically meaningful end points, there was no improvement in outcomes associated with this therapy. Results from this propensity analysis provide additional justification for equipoise regarding corticosteroid therapy for pediatric septic shock and ascertain the need for a well-designed clinical trial to examine benefit/risk for this intervention.
Details
- Title: Subtitle
- The Association of Early Corticosteroid Therapy With Clinical and Health-Related Quality of Life Outcomes in Children With Septic Shock
- Creators
- Nicole N. Kamps - University of Wisconsin American Family Children's HospitalRussell Banks - University of UtahRon W. Reeder - University of UtahRobert A. Berg - Children's Hospital of PhiladelphiaChristopher J. Newth - Children's Hospital of Los AngelesMurray M. Pollack - Children's NationalKathleen L. Meert - Children's Hospital of MichiganJoseph A. Carcillo - University of PittsburghPeter M. Mourani - University of Colorado HospitalSamuel Sorenson - University of UtahJames W. Varni - Texas A&M Univ, Dept Pediat, College Stn, TX USAPelin Cengiz - University of Wisconsin American Family Children's HospitalJerry J. Zimmerman - University of WashingtonLife After Pediatric Sepsis Evaluation (LAPSE) Investigators
- Resource Type
- Journal article
- Publication Details
- Pediatric critical care medicine, Vol.23(9), pp.687-697
- DOI
- 10.1097/PCC.0000000000003009
- PMID
- 35695852
- PMCID
- PMC9444900
- NLM abbreviation
- Pediatr Crit Care Med
- ISSN
- 1529-7535
- eISSN
- 1947-3893
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 11
- Grant note
- R01HD073362 / Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
- Language
- English
- Date published
- 09/01/2022
- Academic Unit
- Critical Care; Stead Family Department of Pediatrics
- Record Identifier
- 9984354055002771
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