Association between corticosteroid use and 28-day mortality in septic shock patients with gram-negative bacterial infection: a retrospective study
PurposeAlthough corticosteroids are recommended in the 2021 Surviving Sepsis Campaign (SSC) guidelines, evidence with respect to their effects on short-term mortality remains conflicting. We conducted this study to identify whether corticosteroids alter 28-day mortality in septic shock patients with...
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Frontiers Media S.A.
2023-11-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2023.1276181/full |
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| author | Yi Dong Yi Dong Gang Heng Jianxin Zhang Yanbing Shen Zhen Lan Kunchen Wei Weidong Jin Weidong Jin |
| author_facet | Yi Dong Yi Dong Gang Heng Jianxin Zhang Yanbing Shen Zhen Lan Kunchen Wei Weidong Jin Weidong Jin |
| author_sort | Yi Dong |
| collection | DOAJ |
| description | PurposeAlthough corticosteroids are recommended in the 2021 Surviving Sepsis Campaign (SSC) guidelines, evidence with respect to their effects on short-term mortality remains conflicting. We conducted this study to identify whether corticosteroids alter 28-day mortality in septic shock patients with gram-negative bacterial infection.Materials and methodsA total of 621 patients with septic shock and gram-negative bacterial culture results were identified from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Propensity score matching (PSM) was performed, and Kaplan–Meier survival curve analyses with log-rank tests were used to determine the relationship between corticosteroid use and the risk of 28-day mortality. Subgroup analyses were conducted to assess whether the conclusions were stable and reliable.ResultsCorticosteroid administration was associated with increased 28-day mortality in septic shock patients with gram-negative bacterial infection (log-rank test P = 0.028). The incidence of Stage 2 or 3 AKI and the rate of hospital mortality were higher among patients who received corticosteroids. The incidence of Stage 2 or 3 AKI in the early period significantly mediated the relationship between corticosteroid use and 28-day mortality [P =0.046 for the average causal mediation effect (ACME)]. Interaction tests indicated that the effect of corticosteroid use was maintained in patients with a neutrophil-to-lymphocyte ratio (NLR) of <20 (P-value for interaction = 0.027).ConclusionSystemic corticosteroid use could be harmful in septic shock patients with gram-negative bacterial infection, especially in patients with relatively low NLR. |
| first_indexed | 2024-03-11T12:23:44Z |
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| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-03-11T12:23:44Z |
| publishDate | 2023-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-5b4d8fc1c951484a94fe1cbe41b3b8cb2023-11-06T15:46:42ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-11-011010.3389/fmed.2023.12761811276181Association between corticosteroid use and 28-day mortality in septic shock patients with gram-negative bacterial infection: a retrospective studyYi Dong0Yi Dong1Gang Heng2Jianxin Zhang3Yanbing Shen4Zhen Lan5Kunchen Wei6Weidong Jin7Weidong Jin8Department of General Surgery, General Hospital of Central Theater Command, Wuhan, ChinaThe First School of Clinical Medicine, Southern Medical University, Guangzhou, ChinaDepartment of General Surgery, General Hospital of Central Theater Command, Wuhan, ChinaDepartment of General Surgery, General Hospital of Central Theater Command, Wuhan, ChinaDepartment of General Surgery, General Hospital of Central Theater Command, Wuhan, ChinaDepartment of General Surgery, General Hospital of Central Theater Command, Wuhan, ChinaDepartment of Respiratory and Critical Care Medicine, Changzheng Hospital, Navy Medical University, Shanghai, ChinaDepartment of General Surgery, General Hospital of Central Theater Command, Wuhan, ChinaThe First School of Clinical Medicine, Southern Medical University, Guangzhou, ChinaPurposeAlthough corticosteroids are recommended in the 2021 Surviving Sepsis Campaign (SSC) guidelines, evidence with respect to their effects on short-term mortality remains conflicting. We conducted this study to identify whether corticosteroids alter 28-day mortality in septic shock patients with gram-negative bacterial infection.Materials and methodsA total of 621 patients with septic shock and gram-negative bacterial culture results were identified from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Propensity score matching (PSM) was performed, and Kaplan–Meier survival curve analyses with log-rank tests were used to determine the relationship between corticosteroid use and the risk of 28-day mortality. Subgroup analyses were conducted to assess whether the conclusions were stable and reliable.ResultsCorticosteroid administration was associated with increased 28-day mortality in septic shock patients with gram-negative bacterial infection (log-rank test P = 0.028). The incidence of Stage 2 or 3 AKI and the rate of hospital mortality were higher among patients who received corticosteroids. The incidence of Stage 2 or 3 AKI in the early period significantly mediated the relationship between corticosteroid use and 28-day mortality [P =0.046 for the average causal mediation effect (ACME)]. Interaction tests indicated that the effect of corticosteroid use was maintained in patients with a neutrophil-to-lymphocyte ratio (NLR) of <20 (P-value for interaction = 0.027).ConclusionSystemic corticosteroid use could be harmful in septic shock patients with gram-negative bacterial infection, especially in patients with relatively low NLR.https://www.frontiersin.org/articles/10.3389/fmed.2023.1276181/fullcorticosteroidsgram-negative bacterial infectionseptic shockacute kidney injuryimmunosuppression |
| spellingShingle | Yi Dong Yi Dong Gang Heng Jianxin Zhang Yanbing Shen Zhen Lan Kunchen Wei Weidong Jin Weidong Jin Association between corticosteroid use and 28-day mortality in septic shock patients with gram-negative bacterial infection: a retrospective study Frontiers in Medicine corticosteroids gram-negative bacterial infection septic shock acute kidney injury immunosuppression |
| title | Association between corticosteroid use and 28-day mortality in septic shock patients with gram-negative bacterial infection: a retrospective study |
| title_full | Association between corticosteroid use and 28-day mortality in septic shock patients with gram-negative bacterial infection: a retrospective study |
| title_fullStr | Association between corticosteroid use and 28-day mortality in septic shock patients with gram-negative bacterial infection: a retrospective study |
| title_full_unstemmed | Association between corticosteroid use and 28-day mortality in septic shock patients with gram-negative bacterial infection: a retrospective study |
| title_short | Association between corticosteroid use and 28-day mortality in septic shock patients with gram-negative bacterial infection: a retrospective study |
| title_sort | association between corticosteroid use and 28 day mortality in septic shock patients with gram negative bacterial infection a retrospective study |
| topic | corticosteroids gram-negative bacterial infection septic shock acute kidney injury immunosuppression |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2023.1276181/full |
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