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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.
SUBMITTER: Atkinson SJ
PROVIDER: S-EPMC4227847 | biostudies-literature | 2014
REPOSITORIES: biostudies-literature
Atkinson Sarah J SJ Cvijanovich Natalie Z NZ Thomas Neal J NJ Allen Geoffrey L GL Anas Nick N Bigham Michael T MT Hall Mark M Freishtat Robert J RJ Sen Anita A Meyer Keith K Checchia Paul A PA Shanley Thomas P TP Nowak Jeffrey J Quasney Michael M Weiss Scott L SL Banschbach Sharon S Beckman Eileen E Howard Kelli K Frank Erin E Harmon Kelli K Lahni Patrick P Lindsell Christopher J CJ Wong Hector R HR
PloS one 20141111 11
<h4>Background</h4>The potential benefits of corticosteroids for septic shock may depend on initial mortality risk.<h4>Objective</h4>We determined associations between corticosteroids and outcomes in children with septic shock who were stratified by initial mortality risk.<h4>Methods</h4>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 str ...[more]