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This article is part of the supplement: 31st International Symposium on Intensive Care and Emergency Medicine

Poster presentation

Early administration of hydrocortisone replacement after advent of septic shock is a major determinant of final outcome

C Katsenos1*, I Tsagkaris2, A Antonopoulou2, A Savva2, A Michaloglou1, E Giamarellos-Bourboulis3, A Armaganidis2 and K Mandragos1

  • * Corresponding author: C Katsenos

Author Affiliations

1 Korgialeneio Benakeio Hospital, Athens, Greece

2 University of Athens, Medical School, Athens, Greece

3 Attikon University Hospital, Athens, Greece

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Critical Care 2011, 15(Suppl 1):P412  doi:10.1186/cc9832

The electronic version of this article is the complete one and can be found online at: http://ccforum.com/content/15/S1/P412


Published:11 March 2011

© 2011 Katsenos et al.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction

The CORTICUS trial doubts the value of hydrocortisone replacement for final outcome of septic shock [1]. We hypothesized that the time of starting hydrocortisone may impact on the final outcome.

Methods

Retrospective analysis was made of prospectively collected data for 41 patients with septic shock (ACCP/SCCM 1992 definition) in the past year in two ICUs. Hydrocortisone was infused as suggested [2]. The time lapsing from start of vasopressors until start of hydrocortisone was determined by the patients' charts.

Results

Early start of hydrocortisone was determined by the quartiles of lapsing time as less than 24 hours. The impact of early start is shown in Figure 1. The mean APACHE II score for patients in early start was 22.09 and for patients in late start was 18.33 (P = NS). Cox regression analysis revealed that the only factor affecting final outcome was early start of hydrocortisone (HR: 4.85, 95% CI: 1.11 to 21.22, P = 0.036) as opposed to appropriateness of antimicrobial treatment (HR: 2.80, 95% CI: 0.56 to 13.91, P = NS).

thumbnailFigure 1. Survival in relation to start of hydrocortisone.

Conclusions

Despite the observational approach, early start of hydrocortisone replacement in septic shock is a critical factor for outcome.

References

  1. Sprung CL, et al.:

    N Engl J Med. 2008, 358:111. PubMed Abstract | Publisher Full Text OpenURL

  2. Marik PE, et al.:

    Crit Care Med. 2008, 36:1937. PubMed Abstract | Publisher Full Text OpenURL