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. 2024 Jan:170:115961.
doi: 10.1016/j.biopha.2023.115961. Epub 2023 Nov 30.

Hydrocortisone-associated death and hospital length of stay in patients with sepsis: A retrospective cohort of large-scale clinical care data

Mohan Li  1 , Raymond Noordam  2 , Elizabeth M Winter  1 , Matijs van Meurs  3 , Hjalmar R Bouma  4 , M Sesmu Arbous  5 , Patrick C N Rensen  1 , Sander Kooijman  6
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Free article

Hydrocortisone-associated death and hospital length of stay in patients with sepsis: A retrospective cohort of large-scale clinical care data

Mohan Li et al. Biomed Pharmacother. 2024 Jan.
Free article

Abstract

Purpose: Sepsis is one of the leading causes of morbidity and mortality worldwide with approximately 50 million annual cases. There is ongoing debate on the clinical benefit of hydrocortisone in the prevention of death in septic patients. Here we evaluated the association between hydrocortisone treatment and mortality in patients diagnosed with sepsis in a large-scale clinical dataset.

Methods: Data from patients between 2008 and 2019 were extracted from the retrospective Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients who received hydrocortisone after diagnosis were matched using propensity-score matching with patients who did not, to balance confounding (by indication and contraindication) factors between the groups. 90-day mortality and survivors' length of hospital stay was compared between patients who did or did not receive hydrocortisone.

Results: A total of 31,749 septic patients were included in the study (mean age: 67, men: 57.3%, in-hospital mortality: 15.6%). 90-day mortality was higher among the 1802 patients receiving hydrocortisone when compared with the 6348 matched non-users (hazard ratio: 1.35, 95% CI: 1.24-1.47). Hydrocortisone treatment was also associated with increased in-hospital mortality (40.9% vs. 27.6%, p < 0.0001) and prolonged hospital stay in those who survived until discharge (median 12.6 days vs. 10.8 days, p < 0.0001). Stratification for age, gender, ethnicity, occurrence of septic shock, and the need for vasopressor drug administration such as (nor)epinephrine did not reveal sub-population(s) benefiting of hydrocortisone use.

Conclusion: Hydrocortisone treatment is associated with increased risk of death as well as prolonged hospital stay in septic patients. Although residual confounding (by indication) cannot be ruled out completely due to the observational nature of the study, the present study suggests clinical implication of hydrocortisone use in patients with sepsis.

Keywords: Hydrocortisone; Pharmacoepidemiology; Prognosis; Propensity score matching; Sepsis.

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Conflict of interest statement

Declaration of Competing Interest I, Mohan Li, hereby declare that there is no conflict of interest pertaining to the research work titled " Hydrocortisone-associated death and hospital length of stay in patients with sepsis: A retrospective cohort of large-scale clinical care data" submitted for consideration to be published in Biomedicine & Pharmacotherapy. Throughout the course of this research, no financial or non-financial relationships or activities that could potentially influence or bias the findings, interpretations, or conclusions of this work have been present. Additionally, there are no affiliations with any organization, company, or individual that might create a conflict of interest in connection with this research. I confirm that this Declaration of Interest is accurate and complete to the best of my knowledge.

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