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Abstract

Introduction: The efficacy and safety of steroids in cancer patients with septic shock have not been well described. Previous studies had a small number of cancer patients; in addition, those with an advanced form of cancer, immunosuppression, or prior steroid treatment were excluded. Hypothesis: We describe the efficacy and safety of low dose hydrocortisone (HC) in cancer patients with septic shock. Methods: The ICU database was used to identify adult cancer patients with the diagnosis of septic shock admitted to the ICU between Jan 2007 and Dec 2010. Eligible patients should have received HC (? 300 mg/day) for at least 24 hrs, as part of the septic shock treatment protocol. Patient demographics, past steroid history, and the cosyntropin test results were recorded. Efficacy was assessed by determining the proportion of patients with reversal of septic shock (off vasopressors?24 hr), time to reversal, and ICU mortality. Safety was assessed by determining the incidence of hyperglycemia (>150 mg/dL), hypernatremia (>150 mEq/ml), and superinfection (new positive cultures > 48 hours after initiating HC). Results: During the study period, 39 patients were identified; mean age was 55.4 years, 24 (61.5%) were males, and mean APACHE II was 23.4. Steroid use within the past 4 weeks was reported in 27 (69.2%) patients. Cosyntropin test at the onset of septic shock was available for 16 patients, 7 (43.7%) of whom had no response to corticotropin (?9 mcg/dL increase in cortisol level). Reversal of septic shock was reported in 27 (69.2%) patients, median time for shock reversal was 1.3 days (range 0.3 to 7.6), and ICU mortality was reported in 25 (64.1%) patients. Of the 16 patients with cosyntropin test, shock reversal was reported in 7 patients who had a response to corticotropin and 5 patients who were non-responders. Hyperglycemia, hypernatremia and superinfection were reported in 31 (79.5%), 4(10.3%), and 17 (43.6%) patients, respectively. Conclusions: Despite resolution of septic shock in about 70% of the patients, the incidence of superinfection and mortality rate were high. Larger studies are needed to describe the benefits and risks of HC in cancer patients with septic shock.