Association Between Different Glucocorticoids and Mortality in ICU Patients With Sepsis-Related Acute Respiratory Distress Syndrome: A Retrospective Cohort Study From MIMIC-IV Database.

BACKGROUND

The comparative effectiveness of specific glucocorticoids (methylprednisolone, hydrocortisone, and dexamethasone) and the impact of dosing intensity on outcomes in sepsis-associated acute respiratory distress syndrome (ARDS) remain poorly characterized.

METHODS

This retrospective cohort study analyzed adults with sepsis-associated ARDS from the Medical Information Mart for Intensive Care IV database. Patients were classified by glucocorticoid type and dose (low-dose: <88 mg/day methylprednisolone equivalent; high-dose: ≥88 mg/day). The primary outcome was 28-day mortality, analyzed using multivariable Cox models with hazard ratio (HR) and 95% confidence interval (CI). Subgroup analyses and propensity score matching (PSM) were performed to validate the findings.

RESULTS

Among 896 patients, 443 (49.4%) died within 28 days. Compared with hydrocortisone, both methylprednisolone (adjusted HR = 0.71, 95% CI 0.57-0.89) and dexamethasone (adjusted HR = 0.61, 95% CI 0.44-0.86) were associated with lower 28-day mortality. High-dose therapy was associated with increased mortality versus low-dose (adjusted HR = 1.56, 95% CI 1.23-1.97). Results were consistent across subgroups and in PSM analyses.

CONCLUSION

In sepsis-associated ARDS, glucocorticoid selection and dose are associated with survival. Methylprednisolone and dexamethasone were associated with lower mortality compared with hydrocortisone, while high-dose therapy was linked to increased mortality.