TY - JOUR
T1 - Corticosteroids and pediatric septic shock outcomes
T2 - A risk stratified analysis
AU - Atkinson, Sarah J.
AU - Cvijanovich, Natalie Z.
AU - Thomas, Neal J.
AU - Allen, Geoffrey L.
AU - Anas, Nick
AU - Bigham, Michael T.
AU - Hall, Mark
AU - Freishtat, Robert J.
AU - Sen, Anita
AU - Meyer, Keith
AU - Checchia, Paul A.
AU - Shanley, Thomas P.
AU - Nowak, Jeffrey
AU - Quasney, Michael
AU - Weiss, Scott L.
AU - Banschbach, Sharon
AU - Beckman, Eileen
AU - Howard, Kelli
AU - Frank, Erin
AU - Harmon, Kelli
AU - Lahni, Patrick
AU - Lindsell, Christopher J.
AU - Wong, Hector R.
N1 - Publisher Copyright:
© 2014 PLOS ONE.
PY - 2014/11/11
Y1 - 2014/11/11
N2 - 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.
AB - 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.
UR - https://www.scopus.com/pages/publications/84956619811
U2 - 10.1371/journal.pone.0112702
DO - 10.1371/journal.pone.0112702
M3 - Article
C2 - 25386653
AN - SCOPUS:84956619811
SN - 1932-6203
VL - 9
JO - PLoS ONE
JF - PLoS ONE
IS - 11
M1 - e112702
ER -