Global utilization of low-dose corticosteroids in severe sepsis and septic shock: a report from the PROGRESS registry
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Auteurs : Richard Beale [Royaume-Uni] ; Jonathan M. Janes [États-Unis] ; Frank M. Brunkhorst [Allemagne] ; Geoffrey Dobb [Australie] ; Mitchell M. Levy [États-Unis] ; Greg S. Martin [États-Unis] ; Graham Ramsay [Royaume-Uni] ; Eliezer Silva [Brésil] ; Charles L. Sprung [Israël] ; Benoit Vallet [France] ; Jean-Louis Vincent [Belgique] ; Timothy M. Costigan [États-Unis] ; Amy G. Leishman [États-Unis] ; Mark D. Williams [États-Unis] ; Konrad Reinhart [Allemagne]Source :
- Critical Care [ 1364-8535 ] ; 2010.
Abstract
The benefits and use of low-dose corticosteroids (LDCs) in severe sepsis and septic shock remain controversial. Surviving sepsis campaign guidelines suggest LDC use for septic shock patients poorly responsive to fluid resuscitation and vasopressor therapy. Their use is suspected to be wide-spread, but paucity of data regarding global practice exists. The purpose of this study was to compare baseline characteristics and clinical outcomes of patients treated or not treated with LDC from the international PROGRESS (PROmoting Global Research Excellence in Severe Sepsis) cohort study of severe sepsis.
Patients enrolled in the PROGRESS registry were evaluated for use of vasopressor and LDC (equivalent or lesser potency to hydrocortisone 50 mg six-hourly plus 50 μg 9-alpha-fludrocortisone) for treatment of severe sepsis at any time in intensive care units (ICUs). Baseline characteristics and hospital mortality were analyzed, and logistic regression techniques used to develop propensity score and outcome models adjusted for baseline imbalances between groups.
A total of 8,968 patients with severe sepsis and sufficient data for analysis were studied. A total of 79.8% (7,160/8,968) of patients received vasopressors, and 34.0% (3,051/8,968) of patients received LDC. Regional use of LDC was highest in Europe (51.1%) and lowest in Asia (21.6%). Country use was highest in Brazil (62.9%) and lowest in Malaysia (9.0%). A total of 14.2% of patients on LDC were not receiving any vasopressor therapy. LDC patients were older, had more co-morbidities and higher disease severity scores. Patients receiving LDC spent longer in ICU than patients who did not (median of 12 versus 8 days;
Widespread use of LDC for the treatment of severe sepsis with significant regional and country variation exists. In this study, 14.2% of patients received LDC despite the absence of evidence of shock. Hospital mortality was higher in the LDC group and remained higher after adjustment for key determinates of mortality.
Url:
DOI: 10.1186/cc9044
PubMed: 20525247
PubMed Central: 2911744
Affiliations:
- Allemagne, Australie, Belgique, Brésil, France, Israël, Royaume-Uni, États-Unis
- Géorgie (États-Unis), Indiana, Rhode Island, Région de Bruxelles-Capitale
- Bruxelles
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Janes</name><affiliation wicri:level="2"><nlm:aff id="I3">Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285</wicri:regionArea><placeName><region type="state">Indiana</region></placeName></affiliation></author><author><name sortKey="Brunkhorst, Frank M" sort="Brunkhorst, Frank M" uniqKey="Brunkhorst F" first="Frank M" last="Brunkhorst">Frank M. Brunkhorst</name><affiliation wicri:level="1"><nlm:aff id="I4">Department of Anesthesiology and Intensive Care, Friedrich-Schiller University, Erlanger Allee 101, Jena, 07743, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Anesthesiology and Intensive Care, Friedrich-Schiller University, Erlanger Allee 101, Jena, 07743</wicri:regionArea><wicri:noRegion>07743</wicri:noRegion><wicri:noRegion>07743</wicri:noRegion><wicri:noRegion>07743</wicri:noRegion></affiliation></author><author><name sortKey="Dobb, Geoffrey" sort="Dobb, Geoffrey" uniqKey="Dobb G" first="Geoffrey" last="Dobb">Geoffrey Dobb</name><affiliation wicri:level="1"><nlm:aff id="I5">Royal Perth Hospital, Wellington Street, Perth, WA, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Royal Perth Hospital, Wellington Street, Perth, WA</wicri:regionArea><wicri:noRegion>WA</wicri:noRegion></affiliation></author><author><name sortKey="Levy, Mitchell M" sort="Levy, Mitchell M" uniqKey="Levy M" first="Mitchell M" last="Levy">Mitchell M. Levy</name><affiliation wicri:level="2"><nlm:aff id="I6">Medical Intensive Care Unit, Rhode Island Hospital, 593 Eddy Street, MICU Main 7, Providence, RI 02903, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Medical Intensive Care Unit, Rhode Island Hospital, 593 Eddy Street, MICU Main 7, Providence, RI 02903</wicri:regionArea><placeName><region type="state">Rhode Island</region></placeName></affiliation></author><author><name sortKey="Martin, Greg S" sort="Martin, Greg S" uniqKey="Martin G" first="Greg S" last="Martin">Greg S. Martin</name><affiliation wicri:level="2"><nlm:aff id="I7">Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Emory University, 49 Jesse Hill Jr Drive S. E., Atlanta, GA 30303, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Emory University, 49 Jesse Hill Jr Drive S. E., Atlanta, GA 30303</wicri:regionArea><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Ramsay, Graham" sort="Ramsay, Graham" uniqKey="Ramsay G" first="Graham" last="Ramsay">Graham Ramsay</name><affiliation wicri:level="1"><nlm:aff id="I8">Mid Essex Hospital Services NHS Trust, Broomfield Hospital, Court Road, Broomfield, Chelmsford, CM1 7WE, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Mid Essex Hospital Services NHS Trust, Broomfield Hospital, Court Road, Broomfield, Chelmsford, CM1 7WE</wicri:regionArea><wicri:noRegion>CM1 7WE</wicri:noRegion></affiliation></author><author><name sortKey="Silva, Eliezer" sort="Silva, Eliezer" uniqKey="Silva E" first="Eliezer" last="Silva">Eliezer Silva</name><affiliation wicri:level="1"><nlm:aff id="I9">Intensive Care Unit, Hospital Israelita Albert Einstein, Avenida Albert Einstein 627, Sao Paulo, 05651-901, Brazil</nlm:aff><country xml:lang="fr">Brésil</country><wicri:regionArea>Intensive Care Unit, Hospital Israelita Albert Einstein, Avenida Albert Einstein 627, Sao Paulo, 05651-901</wicri:regionArea><wicri:noRegion>05651-901</wicri:noRegion></affiliation></author><author><name sortKey="Sprung, Charles L" sort="Sprung, Charles L" uniqKey="Sprung C" first="Charles L" last="Sprung">Charles L. Sprung</name><affiliation wicri:level="1"><nlm:aff id="I10">Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Ein-Karem, Jerusalem, Israel</nlm:aff><country xml:lang="fr">Israël</country><wicri:regionArea>Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Ein-Karem, Jerusalem</wicri:regionArea><wicri:noRegion>Jerusalem</wicri:noRegion></affiliation></author><author><name sortKey="Vallet, Benoit" sort="Vallet, Benoit" uniqKey="Vallet B" first="Benoit" last="Vallet">Benoit Vallet</name><affiliation wicri:level="1"><nlm:aff id="I11">Department of Anesthesiology and Intensive Care, University Hospital of Lille, Univ Lille Nord de France, F-590000, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Anesthesiology and Intensive Care, University Hospital of Lille, Univ Lille Nord de France, F-590000</wicri:regionArea><wicri:noRegion>590000</wicri:noRegion><wicri:noRegion>590000</wicri:noRegion></affiliation></author><author><name sortKey="Vincent, Jean Louis" sort="Vincent, Jean Louis" uniqKey="Vincent J" first="Jean-Louis" last="Vincent">Jean-Louis Vincent</name><affiliation wicri:level="3"><nlm:aff id="I12">Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium</nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels</wicri:regionArea><placeName><settlement type="city">Bruxelles</settlement><region nuts="2">Région de Bruxelles-Capitale</region></placeName></affiliation></author><author><name sortKey="Costigan, Timothy M" sort="Costigan, Timothy M" uniqKey="Costigan T" first="Timothy M" last="Costigan">Timothy M. Costigan</name><affiliation wicri:level="2"><nlm:aff id="I3">Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285</wicri:regionArea><placeName><region type="state">Indiana</region></placeName></affiliation></author><author><name sortKey="Leishman, Amy G" sort="Leishman, Amy G" uniqKey="Leishman A" first="Amy G" last="Leishman">Amy G. Leishman</name><affiliation wicri:level="2"><nlm:aff id="I3">Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285</wicri:regionArea><placeName><region type="state">Indiana</region></placeName></affiliation></author><author><name sortKey="Williams, Mark D" sort="Williams, Mark D" uniqKey="Williams M" first="Mark D" last="Williams">Mark D. Williams</name><affiliation wicri:level="2"><nlm:aff id="I3">Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285</wicri:regionArea><placeName><region type="state">Indiana</region></placeName></affiliation></author><author><name sortKey="Reinhart, Konrad" sort="Reinhart, Konrad" uniqKey="Reinhart K" first="Konrad" last="Reinhart">Konrad Reinhart</name><affiliation wicri:level="1"><nlm:aff id="I4">Department of Anesthesiology and Intensive Care, Friedrich-Schiller University, Erlanger Allee 101, Jena, 07743, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Anesthesiology and Intensive Care, Friedrich-Schiller University, Erlanger Allee 101, Jena, 07743</wicri:regionArea><wicri:noRegion>07743</wicri:noRegion><wicri:noRegion>07743</wicri:noRegion><wicri:noRegion>07743</wicri:noRegion></affiliation></author></analytic><series><title level="j">Critical Care</title><idno type="ISSN">1364-8535</idno><idno type="eISSN">1466-609X</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p>The benefits and use of low-dose corticosteroids (LDCs) in severe sepsis and septic shock remain controversial. Surviving sepsis campaign guidelines suggest LDC use for septic shock patients poorly responsive to fluid resuscitation and vasopressor therapy. Their use is suspected to be wide-spread, but paucity of data regarding global practice exists. The purpose of this study was to compare baseline characteristics and clinical outcomes of patients treated or not treated with LDC from the international PROGRESS (PROmoting Global Research Excellence in Severe Sepsis) cohort study of severe sepsis.</p></sec><sec><title>Methods</title><p>Patients enrolled in the PROGRESS registry were evaluated for use of vasopressor and LDC (equivalent or lesser potency to hydrocortisone 50 mg six-hourly plus 50 μg 9-alpha-fludrocortisone) for treatment of severe sepsis at any time in intensive care units (ICUs). Baseline characteristics and hospital mortality were analyzed, and logistic regression techniques used to develop propensity score and outcome models adjusted for baseline imbalances between groups.</p></sec><sec><title>Results</title><p>A total of 8,968 patients with severe sepsis and sufficient data for analysis were studied. A total of 79.8% (7,160/8,968) of patients received vasopressors, and 34.0% (3,051/8,968) of patients received LDC. Regional use of LDC was highest in Europe (51.1%) and lowest in Asia (21.6%). Country use was highest in Brazil (62.9%) and lowest in Malaysia (9.0%). A total of 14.2% of patients on LDC were not receiving any vasopressor therapy. LDC patients were older, had more co-morbidities and higher disease severity scores. Patients receiving LDC spent longer in ICU than patients who did not (median of 12 versus 8 days; <italic>P </italic><0.001). Overall hospital mortality rates were greater in the LDC than in the non-LDC group (58.0% versus 43.0%; <italic>P </italic><0.001). After adjusting for baseline imbalances, in all mortality models (with vasopressor use), a consistent association remained between LDC and hospital mortality (odds ratios varying from 1.30 to 1.47).</p></sec><sec><title>Conclusions</title><p>Widespread use of LDC for the treatment of severe sepsis with significant regional and country variation exists. In this study, 14.2% of patients received LDC despite the absence of evidence of shock. 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sortKey="Ramsay, Graham" sort="Ramsay, Graham" uniqKey="Ramsay G" first="Graham" last="Ramsay">Graham Ramsay</name></country><country name="États-Unis"><region name="Indiana"><name sortKey="Janes, Jonathan M" sort="Janes, Jonathan M" uniqKey="Janes J" first="Jonathan M" last="Janes">Jonathan M. Janes</name></region><name sortKey="Costigan, Timothy M" sort="Costigan, Timothy M" uniqKey="Costigan T" first="Timothy M" last="Costigan">Timothy M. Costigan</name><name sortKey="Leishman, Amy G" sort="Leishman, Amy G" uniqKey="Leishman A" first="Amy G" last="Leishman">Amy G. Leishman</name><name sortKey="Levy, Mitchell M" sort="Levy, Mitchell M" uniqKey="Levy M" first="Mitchell M" last="Levy">Mitchell M. Levy</name><name sortKey="Martin, Greg S" sort="Martin, Greg S" uniqKey="Martin G" first="Greg S" last="Martin">Greg S. Martin</name><name sortKey="Williams, Mark D" sort="Williams, Mark D" uniqKey="Williams M" first="Mark D" last="Williams">Mark D. Williams</name></country><country name="Allemagne"><noRegion><name sortKey="Brunkhorst, Frank M" sort="Brunkhorst, Frank M" uniqKey="Brunkhorst F" first="Frank M" last="Brunkhorst">Frank M. Brunkhorst</name></noRegion><name sortKey="Reinhart, Konrad" sort="Reinhart, Konrad" uniqKey="Reinhart K" first="Konrad" last="Reinhart">Konrad Reinhart</name></country><country name="Australie"><noRegion><name sortKey="Dobb, Geoffrey" sort="Dobb, Geoffrey" uniqKey="Dobb G" first="Geoffrey" last="Dobb">Geoffrey Dobb</name></noRegion></country><country name="Brésil"><noRegion><name sortKey="Silva, Eliezer" sort="Silva, Eliezer" uniqKey="Silva E" first="Eliezer" last="Silva">Eliezer Silva</name></noRegion></country><country name="Israël"><noRegion><name sortKey="Sprung, Charles L" sort="Sprung, Charles L" uniqKey="Sprung C" first="Charles L" last="Sprung">Charles L. Sprung</name></noRegion></country><country name="France"><noRegion><name sortKey="Vallet, Benoit" sort="Vallet, Benoit" uniqKey="Vallet B" first="Benoit" last="Vallet">Benoit Vallet</name></noRegion></country><country name="Belgique"><region name="Région de Bruxelles-Capitale"><name sortKey="Vincent, Jean Louis" sort="Vincent, Jean Louis" uniqKey="Vincent J" first="Jean-Louis" last="Vincent">Jean-Louis Vincent</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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