ArticleCritical care explorations2025
Evaluation of Hydrocortisone Discontinuation Strategies in Septic Shock: A Retrospective Cohort Study.
Article in Critical care explorations, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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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
1 citing paper in PubMed.
- A clinician's guide to corticosteroid therapy in pneumonia and critical illness: agent selection, dosing, monitoring, and interactions.Pneumonia (Nathan Qld.) · 2026Review
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7 authors.
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Abstract
importanceWhile corticosteroid administration in septic shock has been shown to reduce vasopressor requirements and accelerate shock reversal, the optimal discontinuation strategy remains unexplored.
objectivesThe purpose of this study was to assess whether rates of hemodynamic instability differ among patients with septic shock undergoing abrupt hydrocortisone discontinuation compared with gradual tapering. DESIGN, SETTING, AND
participantsA retrospective cohort study conducted in five medical and surgical ICUs at a tertiary care hospital, involving adult patients (≥ 18 yr) with septic shock who received at least 48 hours of stress-dose hydrocortisone (≥ 200 mg/d). MAIN OUTCOMES AND MEASURES: The primary outcome was hemodynamic instability, defined as vasopressor reinitiation during tapering or within 72 hours of hydrocortisone discontinuation. Secondary outcomes included dysglycemia, duration of mechanical ventilation, ICU and hospital length of stay, and mortality.
resultsPatients were grouped based on their hydrocortisone discontinuation strategy into abrupt and gradual tapering groups. A total of 414 patients were included in this evaluation. Gradual tapering was associated with higher rates of hemodynamic instability (29.2% vs. 12.9%; p < 0.001), more frequent dysglycemia (59.4% vs. 43.1%; p < 0.001), longer hydrocortisone use (9.9 vs. 4.1 d; p < 0.001), and extended mechanical ventilation (20 vs. 15 d; p = 0.014) and ICU stay (23 vs. 17 d; p = 0.008). Total hydrocortisone duration was the strongest independent predictor of post-discontinuation hemodynamic instability, regardless of strategy (adjusted odds ratio, 1.083; 95% CI, 1.025-1.145; p = 0.004). CONCLUSIONS AND RELEVANCE: While abrupt hydrocortisone discontinuation was associated with fewer ICU-related adverse events, hydrocortisone duration was the primary factor influencing hemodynamic instability post-discontinuation among patients with septic shock. Prospective studies are needed to determine the optimal discontinuation strategy in septic shock.
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