Abstract
BackgroundThe role of low-dose corticosteroid as an adjunctive treatment for abdominal septic shock remains controversial.MethodsWe identified refractory septic shock patients who required noradrenaline and at least one of other vasopressor/inotropic (dopamine, dobutamine or vasopressin) following emergency open laparotomy for perforation of the lower intestinal tract between July 2010 and March 2013 using the Japanese Diagnosis Procedure Combination inpatient database. In-hospital mortality was compared between the low-dose corticosteroid and control groups.ResultsThere were 2164 eligible patients (155 in the corticosteroid group, 2009 in the control group). We observed no significant difference between the groups in terms of in-hospital mortality in the unadjusted analysis [corticosteroid vs. control groups, 19.4 and 25.1 %, respectively; difference, −5.7 %; 95 % confidence interval (CI), −12.8 to 1.3]; however, a significant difference in in-hospital mortality was evident in the propensity score-weighted analysis (17.6 and 25.0 %, respectively; difference, −7.4 %; 95 % CI −9.9 to −5.0). An instrumental variable analysis with the hospital low-dose corticosteroid prescription proportion showed that receipt of low-dose corticosteroid was significantly associated with reduction in in-hospital mortality (differences, −13.5 %; 95 % CI −24.6 to −2.3).ConclusionsLow-dose corticosteroid administration may be associated with reduced in-hospital mortality in patients with refractory septic shock following emergency laparotomy for lower intestinal perforation.
Highlights
The role of low-dose corticosteroid as an adjunctive treatment for abdominal septic shock remains controversial
The patients were divided into the low-dose corticosteroid group (n = 155) and control group (n = 2009) (Fig. 1)
A comparison of the unadjusted groups indicated that patients were more likely to receive low-dose corticosteroid treatment if they required more vasopressin, more carbapenem, or blood transfusion
Summary
The role of low-dose corticosteroid as an adjunctive treatment for abdominal septic shock remains controversial. Despite recent developments in the diagnosis and treatment of sepsis, mortality in septic shock patients remains unacceptably high [1,2,3]. In clinical practice, Recent landmark trials and meta-analyses of randomized controlled trials have produced conflicting results about the association between low-dose corticosteroid treatment and patient mortality in sepsis [3, 5, 10,11,12,13,14,15,16,17,18,19,20]. Some meta-analyses have suggested that corticosteroid therapy may more likely benefit patients with severe septic shock that are vasopressor dependent [12, 15, 19]. The Surviving Sepsis Campaign guidelines recommend considering the use of low-dose corticosteroids for patients with septic shock who have responded poorly to fluid resuscitation and vasopressor agents [1]
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