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Clinical impact of stress dose steroids in patients with septic shock: insights from the PROWESS-Shock trial

Póvoa, Pedro ; Salluh, Jorge I F ; Martinez, Maria L ; Guillamat-Prats, Raquel ; Gallup, Dianne ; Al-Khalidi, Hussein R ; Thompson, B Taylor ; Ranieri, V Marco ; Artigas, Antonio

Critical care (London, England), 2015-04, Vol.19 (1), p.193-193, Article 193 [Periódico revisado por pares]

England: BioMed Central Ltd

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Título:
Clinical impact of stress dose steroids in patients with septic shock: insights from the PROWESS-Shock trial
Autor: Póvoa, Pedro ; Salluh, Jorge I F ; Martinez, Maria L ; Guillamat-Prats, Raquel ; Gallup, Dianne ; Al-Khalidi, Hussein R ; Thompson, B Taylor ; Ranieri, V Marco ; Artigas, Antonio
Assuntos: Administration, Intravenous ; Adrenal glands ; Aged ; Analysis ; Anti-Infective Agents - administration & dosage ; Care and treatment ; Clinical trials ; Complications and side effects ; Critical care ; Data analysis ; Female ; Hormones ; Humans ; Intensive care ; Male ; Medical research ; Medicine, Experimental ; Middle Aged ; Mortality ; Pharmaceutical industry ; Protein C - administration & dosage ; Recombinant Proteins - administration & dosage ; Retrospective Studies ; Sepsis ; Septic shock ; Shock, Septic - diagnosis ; Shock, Septic - drug therapy ; Shock, Septic - mortality ; Singers ; Steroids ; Steroids - administration & dosage ; Survival Rate - trends ; Treatment Outcome ; United States
É parte de: Critical care (London, England), 2015-04, Vol.19 (1), p.193-193, Article 193
Notas: ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-News-1
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Descrição: The aim of our study was to evaluate the clinical impact of the administration of intravenous steroids, alone or in conjunction with drotrecogin-alfa (activated) (DrotAA), on the outcomes in septic shock patients. We performed a sub-study of the PROWESS-Shock trial (septic shock patients who received fluids and vasopressors above a predefined threshold for at least 4 hours were randomized to receive either DrotAA or placebo for 96 hours). A propensity score for the administration of intravenous steroids for septic shock at baseline was constructed using multivariable logistic regression. Cox proportional hazards model using inverse probability of treatment weighting of the propensity score was used to estimate the effect of intravenous steroids, alone or in conjunction with DrotAA, on 28-day and 90-day all-cause mortality. A total of 1695 patients were enrolled of which 49.5% received intravenous steroids for treatment of septic shock at baseline (DrotAA + steroids N = 436; DrotAA + no steroids N = 414; placebo + steroids N = 403; placebo + no steroids N = 442). The propensity weighted risk of 28-day as well as 90-day mortality in those treated vs. those not treated with steroids did not differ among those randomized to DrotAA vs. placebo (interaction p-value = 0.38 and p = 0.27, respectively) nor was a difference detected within each randomized treatment. Similarly, the course of vasopressor use and cardiovascular SOFA did not appear to be influenced by steroid therapy. In patients with lung infection (N = 744), abdominal infection (N = 510), Gram-positive sepsis (N = 420) and Gram-negative sepsis (N = 461), the propensity weighted risk of 28-day as well as 90-day mortality in those treated vs. those not treated with steroids did not differ among those randomized to DrotAA vs. placebo nor was a difference detected within each randomized treatment. In the present study of septic shock patients, after adjustment for treatment selection bias, we were unable to find noticeable positive impact from intravenous steroids for treatment of septic shock at baseline either in patients randomized for DrotAA or placebo. Clinicaltrials.gov NCT00604214 . Registered 24 January 2008.
Editor: England: BioMed Central Ltd
Idioma: Inglês

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Clinical impact of stress dose steroids in patients with septic shock: insights from the PROWESS-Shock trial

Póvoa, Pedro ; Salluh, Jorge I F ; Martinez, Maria L ; Guillamat-Prats, Raquel ; Gallup, Dianne ; Al-Khalidi, Hussein R ; Thompson, B Taylor ; Ranieri, V Marco ; Artigas, Antonio

England: BioMed Central Ltd

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