Hydrocortisone use in septic shock: weight-based variability and its effect on length of stay

Abstract

Background In adult patients with refractory septic shock, hydrocortisone (HC) is frequently used at a fixed dose of 200 mg per day. Due to a lack of data, it is unclear if weight-based dosing would be more appropriate – particularly among obese patients – and if such dosing would impact length of stay (LOS) outcomes. Objective To evaluate whether or not fixed doses of HC in septic shock are associated with similar LOS outcomes in non-obese and morbidly obese adult patients. Methods In this retrospective cohort study, medical ICU adult patients who received HC for septic shock at an academic medical center between November 1, 2013 and October 27, 2016 were reviewed. Patients were categorized as non-obese (BMI < 30) or morbidly obese (BMI > 40). The primary outcome measures were the mean durations of ICU stay and total hospital stay, and the secondary outcome measure was in-hospital mortality. Results A total of 80 patients were included in the final study cohort (40 in each BMI group). No statistically significant differences were found in the mean LOS in the ICU between the non-obese and morbidly obese groups (6.4 days vs. 8.2 days, respectively; p=0.19) or in the hospital (14.6 days vs. 15.9 days, respectively; p=0.72). In-hospital mortality was similar between the two groups (35% in the non-obese vs. 45% in the morbidly obese, p=0.36). Conclusions In our study cohort of two groups that lie on the opposite ends of the BMI spectrum, non-weight-based dosing of hydrocortisone was not associated with significant differences in LOS or in-hospital mortality outcomes. These findings require stronger evidence before making recommendations for or against fixed dosing. Future research using a prospective, controlled design with a larger sample size is needed to clarify the effects of hydrocortisone and obesity on septic shock outcomes.