ArticleCritical care (London, England)2012
Early initiation of low-dose corticosteroid therapy in the management of septic shock: a retrospective observational study.
Article in Critical care (London, England), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
17 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Corticosteroids for treating sepsis in children and adults.The Cochrane database of systematic reviews · 2025Pooled it
- Corticosteroids for treating sepsis in children and adults.The Cochrane database of systematic reviews · 2019Pooled it
- Corticosteroids for treating sepsis.The Cochrane database of systematic reviews · 2015Pooled it
- Hemodynamic trajectory phenotypes may modify associations between corticosteroid timing and outcomes in septic shock.Journal of clinical monitoring and computing · 2026Article
- A clinician's guide to corticosteroid therapy in pneumonia and critical illness: agent selection, dosing, monitoring, and interactions.Pneumonia (Nathan Qld.) · 2026Review
- A double-edged sword: a narrative review on steroids in sepsis and septic shock.Internal and emergency medicine · 2025Review
- Steroids in severe community-acquired pneumonia.Breathe (Sheffield, England) · 2024Article
- Early Versus Late Initiation of Hydrocortisone in Patients With Septic Shock: A Prospective Study.Cureus · 2023Article
- Simultaneous control of infection and inflammation with keratin-derived antibacterial peptides targeting TLRs and co-receptors.Science translational medicine · 2023Article
- Glucocorticoids in Sepsis: To Be or Not to Be.Frontiers in immunology · 2020Review
- General Adaptation in Critical Illness: Glucocorticoid Receptor-alpha Master Regulator of Homeostatic Corrections.Frontiers in endocrinology · 2020Review
- The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016).Journal of intensive care · 2018Article
- The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016).Acute medicine & surgery · 2018Article
- The impact of hydrocortisone treatment on neutrophil gelatinase-associated lipocalin release in porcine endotoxemic shock.Intensive care medicine experimental · 2017Article
- Prognostic Value of Lactate and Central Venous Oxygen Saturation after Early Resuscitation in Sepsis Patients.PloS one · 2016Article
- Abandon the mouse research ship? Not just yet!Shock (Augusta, Ga.) · 2014Article
- Early administration of corticosteroids and mortality.Critical care (London, England) · 2012Article
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe use of low-dose steroid therapy in the management of septic shock has been extensively studied. However, the association between the timing of low-dose steroid therapy and the outcome has not been evaluated. Therefore, we evaluated whether early initiation of low-dose steroid therapy is associated with mortality in patients with septic shock.
methodsWe retrospectively analyzed the clinical data of 178 patients who received low-dose corticosteroid therapy for septic shock between January 2008 and December 2009. Time-dependent Cox regression models were used to adjust for potential confounding factors in the association between the time to initiation of low-dose corticosteroid therapy and in-hospital mortality.
resultsThe study population consisted of 107 men and 71 women with a median age of 66 (interquartile range, 54 to 71) years. The 28-day mortality was 44% and low-dose corticosteroid therapy was initiated within a median of 8.5 (3.8 to 19.1) hours after onset of septic shock-related hypotension. Median time to initiation of low-dose corticosteroid therapy was significantly shorter in survivors than in non-survivors (6.5 hours versus 10.4 hours; P=0.0135). The mortality rates increased significantly with increasing quintiles of time to initiation of low-dose corticosteroid therapy (P=0.0107 for trend). Other factors associated with 28-day mortality were higher Simplified Acute Physiology Score (SAPS) 3 (P<0.0001) and Sequential Organ Failure Assessment (SOFA) scores (P=0.0007), dose of vasopressor at the time of initiation of low-dose corticosteroid therapy (P<0.0001), need for mechanical ventilation (P=0.0001) and renal replacement therapy (P<0.0001), while the impaired adrenal reserve did not affect 28-day mortality (81% versus 82%; P=0.8679). After adjusting for potential confounding factors, the time to initiation of low-dose corticosteroid therapy was still significantly associated with 28-day mortality (adjusted odds ratio (OR) 1.025, 95% confidence interval (CI) 1.007 to 1.044, P=0.0075). The early therapy group (administered within 6 hours after the onset of septic shock, n=66) had a 37% lower mortality rate than the late therapy group (administered more than 6 hours after the onset of septic shock, n=112) (32% versus 51%, P=0.0132).
conclusionsEarly initiation of low-dose corticosteroid therapy was significantly associated with decreased mortality.
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