Surgical infections · 2026
A Real-World Analysis of Hydrocortisone and Fludrocortisone Prescribing in Surgical Patients with Septic Shock.
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Mahajan Arnav, Beattie Nick, Patel Nilam, Tran Andrew, Ho Vanessa P, Dvorak Justin E
Аннотация
BACKGROUND: Corticosteroid use in septic shock remains controversial, with trials showing conflicting results. Most studies have been conducted in mixed medical-surgical populations, limiting generalizability to surgical patients who face unique risks. We examined how timing of steroid administration affects outcomes in surgical intensive care unit patients with septic shock.
METHODS: In this retrospective cohort study, we analyzed data from 13,512 surgical patients with septic shock using the TriNetX platform. Patients were categorized into four cohorts: no steroids (n = 8,180), any steroid therapy (n = 5,332), early therapy (≤24 h, n = 2,911), and late therapy (>24 h, n = 2,421). We conducted propensity-matched analyses examining 90-day mortality, infectious complications, and surgical complications.
RESULTS: Early steroid administration was associated with lower 90-day mortality compared with no steroids (31.5% vs. 33.3%; hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.62-0.88; p = 0.006), whereas late administration correlated with higher mortality (34.1% vs. 27.1%; HR: 1.26; 95% CI: 1.11-1.43; p < 0.001). Steroids were associated with lower rates of surgical site infections (relative risk [RR]: 0.63; p = 0.032) and wound dehiscence (RR: 0.73; p = 0.019), but higher rates of pneumonia (RR: 1.22; p = 0.003), myopathy (RR: 2.25; p < 0.001), and bowel ischemia (RR: 2.29; p = 0.008).
CONCLUSIONS: In surgical ICU patients with septic shock, the timing of steroid administration impacts outcomes. Early administration was associated with reduced mortality, whereas late administration correlated with increased mortality. Steroids demonstrated a complex profile of beneficial and adverse effects on post-surgical complications. These findings highlight the importance of timing of therapy in surgical septic shock and may help explain conflicting results from previous trials in mixed populations.
METHODS: In this retrospective cohort study, we analyzed data from 13,512 surgical patients with septic shock using the TriNetX platform. Patients were categorized into four cohorts: no steroids (n = 8,180), any steroid therapy (n = 5,332), early therapy (≤24 h, n = 2,911), and late therapy (>24 h, n = 2,421). We conducted propensity-matched analyses examining 90-day mortality, infectious complications, and surgical complications.
RESULTS: Early steroid administration was associated with lower 90-day mortality compared with no steroids (31.5% vs. 33.3%; hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.62-0.88; p = 0.006), whereas late administration correlated with higher mortality (34.1% vs. 27.1%; HR: 1.26; 95% CI: 1.11-1.43; p < 0.001). Steroids were associated with lower rates of surgical site infections (relative risk [RR]: 0.63; p = 0.032) and wound dehiscence (RR: 0.73; p = 0.019), but higher rates of pneumonia (RR: 1.22; p = 0.003), myopathy (RR: 2.25; p < 0.001), and bowel ischemia (RR: 2.29; p = 0.008).
CONCLUSIONS: In surgical ICU patients with septic shock, the timing of steroid administration impacts outcomes. Early administration was associated with reduced mortality, whereas late administration correlated with increased mortality. Steroids demonstrated a complex profile of beneficial and adverse effects on post-surgical complications. These findings highlight the importance of timing of therapy in surgical septic shock and may help explain conflicting results from previous trials in mixed populations.