Corticosteroids and pediatric septic shock outcomes: A risk stratified analysis

Authors

Sarah J. Atkinson
Natalie Z. Cvijanovich
Neal J. ThomasFollow
Geoffrey L. AllenFollow
Nick Anas
Robert J. Freishtat, George Washington UniversityFollow
+17 additional authors

Document Type

Journal Article

Publication Date

11-11-2014

Journal

PLoS ONE

Volume

Volume 9, Issue 11

Inclusive Pages

Article number e112702

Abstract

Background

The potential benefits of corticosteroids for septic shock may depend on initial mortality risk.

Objective

We determined associations between corticosteroids and outcomes in children with septic shock who were stratified by initial mortality risk.

Methods

We conducted a retrospective analysis of an ongoing, multi-center pediatric septic shock clinical and biological database. Using a validated biomarker-based stratification tool (PERSEVERE), 496 subjects were stratified into three initial mortality risk strata (low, intermediate, and high). Subjects receiving corticosteroids during the initial 7 days of admission (n = 252) were compared to subjects who did not receive corticosteroids (n = 244). Logistic regression was used to model the effects of corticosteroids on 28-day mortality and complicated course, defined as death within 28 days or persistence of two or more organ failures at 7 days.

Results

Subjects who received corticosteroids had greater organ failure burden, higher illness severity, higher mortality, and a greater requirement for vasoactive medications, compared to subjects who did not receive corticosteroids. PERSEVERE-based mortality risk did not differ between the two groups. For the entire cohort, corticosteroids were associated with increased risk of mortality (OR 2.3, 95% CI 1.3–4.0, p = 0.004) and a complicated course (OR 1.7, 95% CI 1.1–2.5, p = 0.012). Within each PERSEVERE-based stratum, corticosteroid administration was not associated with improved outcomes. Similarly, corticosteroid administration was not associated with improved outcomes among patients with no comorbidities, nor in groups of patients stratified by PRISM.

Conclusions

Risk stratified analysis failed to demonstrate any benefit from corticosteroids in this pediatric septic shock cohort.

Figures

Comments

Reproduced with permission of PLoS ONE.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

APA Citation

Atkinson, S.J., Cvijanovich, N.Z., Thomas, N.J., Allen, G.L., Anas, N., et al. (2014) Corticosteroids and Pediatric Septic Shock Outcomes: A Risk Stratified Analysis. PLoS ONE 9(11): e112702.

Peer Reviewed

1

Open Access

1