Effect of hydrocortisone versus methylprednisolone on clinical outcomes in oncology patients with septic shock
Background Corticosteroids are used as adjunctive treatment of critical illness-related corticosteroid insufficiency in patients with septic shock. This study aims to compare the impact of hydrocortisone versus methylprednisolone on duration of septic shock in critically ill oncology patients. Metho...
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| Veröffentlicht in: | Journal of oncology pharmacy practice 2021-01, Vol.27 (1), p.54-62 |
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| creator | McDonnell, Emily Collins, Reagan Hernandez, Mike Brown, Anne Rain T. |
| description | Background
Corticosteroids are used as adjunctive treatment of critical illness-related corticosteroid insufficiency in patients with septic shock. This study aims to compare the impact of hydrocortisone versus methylprednisolone on duration of septic shock in critically ill oncology patients.
Methods
Single-center, retrospective cohort study of adult patients receiving hydrocortisone ≥200 mg/day or methylprednisolone ≥40 mg/day with septic shock. The primary outcome was time to shock reversal defined as time to systolic blood pressure ≥90 mmHg without vasopressors for ≥24 h.
Results
Eighty-eight patients were included, 49 patients received hydrocortisone and 39 patients received methylprednisolone. Solid tumor malignancy was more common in the hydrocortisone group, while hematological malignancy was more common in the methylprednisolone group (p = 0.009). Time to shock reversal was similar between hydrocortisone and methylprednisolone groups (72.4 versus 70.4 h; p = 0.825). Intensive care unit mortality occurred in 51.02% versus 53.85% of patients in hydrocortisone versus methylprednisolone, respectively (p = 0.792). Patients who received methylprednisolone had higher rates of mechanical ventilation (89.74% versus 55.1%, p |
| doi_str_mv | 10.1177/1078155220910788 |
| format | Article |
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Corticosteroids are used as adjunctive treatment of critical illness-related corticosteroid insufficiency in patients with septic shock. This study aims to compare the impact of hydrocortisone versus methylprednisolone on duration of septic shock in critically ill oncology patients.
Methods
Single-center, retrospective cohort study of adult patients receiving hydrocortisone ≥200 mg/day or methylprednisolone ≥40 mg/day with septic shock. The primary outcome was time to shock reversal defined as time to systolic blood pressure ≥90 mmHg without vasopressors for ≥24 h.
Results
Eighty-eight patients were included, 49 patients received hydrocortisone and 39 patients received methylprednisolone. Solid tumor malignancy was more common in the hydrocortisone group, while hematological malignancy was more common in the methylprednisolone group (p = 0.009). Time to shock reversal was similar between hydrocortisone and methylprednisolone groups (72.4 versus 70.4 h; p = 0.825). Intensive care unit mortality occurred in 51.02% versus 53.85% of patients in hydrocortisone versus methylprednisolone, respectively (p = 0.792). Patients who received methylprednisolone had higher rates of mechanical ventilation (89.74% versus 55.1%, p < 0.001) and longer intensive care unit and hospital lengths of stay (4.2 versus 11.4 days and 14.3 versus 25.7 days; p < 0.001) compared to hydrocortisone. No differences were seen in incidence of steroid-related adverse effects between groups.
Conclusions
In oncology patients with septic shock, the use of hydrocortisone versus methylprednisolone does not appear to affect time to shock reversal.</description><identifier>ISSN: 1078-1552</identifier><identifier>EISSN: 1477-092X</identifier><identifier>DOI: 10.1177/1078155220910788</identifier><identifier>PMID: 32686618</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Aged ; Anti-Inflammatory Agents - adverse effects ; Anti-Inflammatory Agents - therapeutic use ; Blood pressure ; Clinical outcomes ; Corticosteroids ; Critical Illness ; Female ; Humans ; Hydrocortisone ; Hydrocortisone - adverse effects ; Hydrocortisone - therapeutic use ; Intensive care ; Length of Stay ; Male ; Malignancy ; Mechanical ventilation ; Methylprednisolone ; Methylprednisolone - adverse effects ; Methylprednisolone - therapeutic use ; Middle Aged ; Neoplasms - complications ; Oncology ; Patients ; Retrospective Studies ; Sepsis ; Septic shock ; Shock, Septic - drug therapy ; Solid tumors ; Steroids ; Treatment Outcome</subject><ispartof>Journal of oncology pharmacy practice, 2021-01, Vol.27 (1), p.54-62</ispartof><rights>The Author(s) 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c365t-5b2962f47ee48d86f51a82a6ad2c918e42a090d5abeb2d3f9de7e55fb77139fc3</citedby><cites>FETCH-LOGICAL-c365t-5b2962f47ee48d86f51a82a6ad2c918e42a090d5abeb2d3f9de7e55fb77139fc3</cites><orcidid>0000-0002-3504-2070 ; 0000-0002-6633-1596</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/1078155220910788$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/1078155220910788$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21817,27922,27923,43619,43620</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32686618$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McDonnell, Emily</creatorcontrib><creatorcontrib>Collins, Reagan</creatorcontrib><creatorcontrib>Hernandez, Mike</creatorcontrib><creatorcontrib>Brown, Anne Rain T.</creatorcontrib><title>Effect of hydrocortisone versus methylprednisolone on clinical outcomes in oncology patients with septic shock</title><title>Journal of oncology pharmacy practice</title><addtitle>J Oncol Pharm Pract</addtitle><description>Background
Corticosteroids are used as adjunctive treatment of critical illness-related corticosteroid insufficiency in patients with septic shock. This study aims to compare the impact of hydrocortisone versus methylprednisolone on duration of septic shock in critically ill oncology patients.
Methods
Single-center, retrospective cohort study of adult patients receiving hydrocortisone ≥200 mg/day or methylprednisolone ≥40 mg/day with septic shock. The primary outcome was time to shock reversal defined as time to systolic blood pressure ≥90 mmHg without vasopressors for ≥24 h.
Results
Eighty-eight patients were included, 49 patients received hydrocortisone and 39 patients received methylprednisolone. Solid tumor malignancy was more common in the hydrocortisone group, while hematological malignancy was more common in the methylprednisolone group (p = 0.009). Time to shock reversal was similar between hydrocortisone and methylprednisolone groups (72.4 versus 70.4 h; p = 0.825). Intensive care unit mortality occurred in 51.02% versus 53.85% of patients in hydrocortisone versus methylprednisolone, respectively (p = 0.792). Patients who received methylprednisolone had higher rates of mechanical ventilation (89.74% versus 55.1%, p < 0.001) and longer intensive care unit and hospital lengths of stay (4.2 versus 11.4 days and 14.3 versus 25.7 days; p < 0.001) compared to hydrocortisone. No differences were seen in incidence of steroid-related adverse effects between groups.
Conclusions
In oncology patients with septic shock, the use of hydrocortisone versus methylprednisolone does not appear to affect time to shock reversal.</description><subject>Aged</subject><subject>Anti-Inflammatory Agents - adverse effects</subject><subject>Anti-Inflammatory Agents - therapeutic use</subject><subject>Blood pressure</subject><subject>Clinical outcomes</subject><subject>Corticosteroids</subject><subject>Critical Illness</subject><subject>Female</subject><subject>Humans</subject><subject>Hydrocortisone</subject><subject>Hydrocortisone - adverse effects</subject><subject>Hydrocortisone - therapeutic use</subject><subject>Intensive care</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Malignancy</subject><subject>Mechanical ventilation</subject><subject>Methylprednisolone</subject><subject>Methylprednisolone - adverse effects</subject><subject>Methylprednisolone - therapeutic use</subject><subject>Middle Aged</subject><subject>Neoplasms - complications</subject><subject>Oncology</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Sepsis</subject><subject>Septic shock</subject><subject>Shock, Septic - drug therapy</subject><subject>Solid tumors</subject><subject>Steroids</subject><subject>Treatment Outcome</subject><issn>1078-1552</issn><issn>1477-092X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kEtLxDAUhYMozji6dyUB19UkfSRdyjA-YMCNgruSpjfTjp2mJqnSf2_K-ADB1b2c-91z4CB0TskVpZxfU8IFTVPGSD6t4gDNacJ5RHL2chj2oEXTfYZOnNsSQgRn4hjNYpaJLKNijrqV1qA8NhrXY2WNMtY3znSA38G6weEd-HpsewtVF_R2upgOq7bpGiVbbAavzA4cbrqgqwBsRtxL30DnHf5ofI0d9L5R2NVGvZ6iIy1bB2dfc4Geb1dPy_to_Xj3sLxZRyrOUh-lJcszphMOkIhKZDqlUjCZyYqpnApImCQ5qVJZQsmqWOcVcEhTXXJO41yreIEu9769NW8DOF9szWC7EFmwhGeUiCRPAkX2lLLGOQu66G2zk3YsKCmmgou_BYeXiy_jodxB9fPw3WgAoj3g5AZ-U_81_ATJboWN</recordid><startdate>202101</startdate><enddate>202101</enddate><creator>McDonnell, Emily</creator><creator>Collins, Reagan</creator><creator>Hernandez, Mike</creator><creator>Brown, Anne Rain T.</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TO</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><orcidid>https://orcid.org/0000-0002-3504-2070</orcidid><orcidid>https://orcid.org/0000-0002-6633-1596</orcidid></search><sort><creationdate>202101</creationdate><title>Effect of hydrocortisone versus methylprednisolone on clinical outcomes in oncology patients with septic shock</title><author>McDonnell, Emily ; Collins, Reagan ; Hernandez, Mike ; Brown, Anne Rain T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-5b2962f47ee48d86f51a82a6ad2c918e42a090d5abeb2d3f9de7e55fb77139fc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Anti-Inflammatory Agents - adverse effects</topic><topic>Anti-Inflammatory Agents - therapeutic use</topic><topic>Blood pressure</topic><topic>Clinical outcomes</topic><topic>Corticosteroids</topic><topic>Critical Illness</topic><topic>Female</topic><topic>Humans</topic><topic>Hydrocortisone</topic><topic>Hydrocortisone - adverse effects</topic><topic>Hydrocortisone - therapeutic use</topic><topic>Intensive care</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Malignancy</topic><topic>Mechanical ventilation</topic><topic>Methylprednisolone</topic><topic>Methylprednisolone - adverse effects</topic><topic>Methylprednisolone - therapeutic use</topic><topic>Middle Aged</topic><topic>Neoplasms - complications</topic><topic>Oncology</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Sepsis</topic><topic>Septic shock</topic><topic>Shock, Septic - drug therapy</topic><topic>Solid tumors</topic><topic>Steroids</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McDonnell, Emily</creatorcontrib><creatorcontrib>Collins, Reagan</creatorcontrib><creatorcontrib>Hernandez, Mike</creatorcontrib><creatorcontrib>Brown, Anne Rain T.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><jtitle>Journal of oncology pharmacy practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McDonnell, Emily</au><au>Collins, Reagan</au><au>Hernandez, Mike</au><au>Brown, Anne Rain T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of hydrocortisone versus methylprednisolone on clinical outcomes in oncology patients with septic shock</atitle><jtitle>Journal of oncology pharmacy practice</jtitle><addtitle>J Oncol Pharm Pract</addtitle><date>2021-01</date><risdate>2021</risdate><volume>27</volume><issue>1</issue><spage>54</spage><epage>62</epage><pages>54-62</pages><issn>1078-1552</issn><eissn>1477-092X</eissn><abstract>Background
Corticosteroids are used as adjunctive treatment of critical illness-related corticosteroid insufficiency in patients with septic shock. This study aims to compare the impact of hydrocortisone versus methylprednisolone on duration of septic shock in critically ill oncology patients.
Methods
Single-center, retrospective cohort study of adult patients receiving hydrocortisone ≥200 mg/day or methylprednisolone ≥40 mg/day with septic shock. The primary outcome was time to shock reversal defined as time to systolic blood pressure ≥90 mmHg without vasopressors for ≥24 h.
Results
Eighty-eight patients were included, 49 patients received hydrocortisone and 39 patients received methylprednisolone. Solid tumor malignancy was more common in the hydrocortisone group, while hematological malignancy was more common in the methylprednisolone group (p = 0.009). Time to shock reversal was similar between hydrocortisone and methylprednisolone groups (72.4 versus 70.4 h; p = 0.825). Intensive care unit mortality occurred in 51.02% versus 53.85% of patients in hydrocortisone versus methylprednisolone, respectively (p = 0.792). Patients who received methylprednisolone had higher rates of mechanical ventilation (89.74% versus 55.1%, p < 0.001) and longer intensive care unit and hospital lengths of stay (4.2 versus 11.4 days and 14.3 versus 25.7 days; p < 0.001) compared to hydrocortisone. No differences were seen in incidence of steroid-related adverse effects between groups.
Conclusions
In oncology patients with septic shock, the use of hydrocortisone versus methylprednisolone does not appear to affect time to shock reversal.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>32686618</pmid><doi>10.1177/1078155220910788</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-3504-2070</orcidid><orcidid>https://orcid.org/0000-0002-6633-1596</orcidid></addata></record> |
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| ispartof | Journal of oncology pharmacy practice, 2021-01, Vol.27 (1), p.54-62 |
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| subjects | Aged Anti-Inflammatory Agents - adverse effects Anti-Inflammatory Agents - therapeutic use Blood pressure Clinical outcomes Corticosteroids Critical Illness Female Humans Hydrocortisone Hydrocortisone - adverse effects Hydrocortisone - therapeutic use Intensive care Length of Stay Male Malignancy Mechanical ventilation Methylprednisolone Methylprednisolone - adverse effects Methylprednisolone - therapeutic use Middle Aged Neoplasms - complications Oncology Patients Retrospective Studies Sepsis Septic shock Shock, Septic - drug therapy Solid tumors Steroids Treatment Outcome |
| title | Effect of hydrocortisone versus methylprednisolone on clinical outcomes in oncology patients with septic shock |
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