Early Initiation of Low-Dose Hydrocortisone Therapy for Septic Shock in Geriatric Patients: A Randomized Control Trial

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dc.contributor.authorAgarwal, Mayanken_US
dc.contributor.authorDhar, Minakshien_US
dc.contributor.authorAgarwal, Dishaen_US
dc.contributor.authorMurlidharan, Aishwaryaen_US
dc.date.accessioned2023-06-17T07:19:19Z
dc.date.available2023-06-17T07:19:19Z
dc.date.issued2022-02
dc.description.abstractBackground: The management of septic shock has undergone significant modifications in the past decade. Various studies have concluded that while corticosteroids reduce the duration of shock, they do not have any proven mortality benefit. Moreover, the time of initiation of corticosteroids has been debatable. Since, little literature is available on geriatric patients, we have designed a randomized trial to assess the importance of early initiation of low dose hydrocortisone comparing with the standard therapy. Objectives: To determine the efficacy of early initiation of low dose hydrocortisone in reducing mortality in septic shock in geriatric patients. Methods: We conducted a single blinded, randomized controlled trial at a tertiary care hospital in India. Geriatric patients (age>60 years) fulfilling the criteria for septic shock were included in the study. All the participants were randomly assigned to two arms- intervention and standard therapy group. The outcomes were studied in terms of 28-day mortality, duration of ICU stay, duration of vasopressor requirement and need for mechanical ventilation Results: Total 120 patients were randomized to either Intervention arm (N=61) or the Standard therapy arm (N=59). The number of patients with reversal of shock was higher in the intervention arm (53.4%) but no statistically significant association (p= 0.575) was found. There was no significant difference between the two groups in terms of 28- day mortality, length of ICU stay, need for mechanical ventilation and duration of vasopressor support. Conclusion: This single centre trial demonstrated that there was no survival benefit associated with the early initiation of low dose hydrocortisone treatment in patients with vasopressor-dependent septic shock. It raised the concern that whether steroids are safe in elderly patients with septic shock.en_US
dc.identifier.affiliationsJunior Residenten_US
dc.identifier.affiliationsAdditional Professor and Head, Department of Internal Medicineen_US
dc.identifier.affiliationsMPH, Department of Community and Family and Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhanden_US
dc.identifier.citationAgarwal Mayank, Dhar Minakshi, Agarwal Disha, Murlidharan Aishwarya. Early Initiation of Low-Dose Hydrocortisone Therapy for Septic Shock in Geriatric Patients: A Randomized Control Trial. Journal of the Association of Physicians of India. 2022 Feb; 70(2): 45b-50en_US
dc.identifier.issn0004 – 5772
dc.identifier.placeIndiaen_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/216133
dc.languageenen_US
dc.publisherAssociation of Physicians of Indiaen_US
dc.relation.issuenumber2en_US
dc.relation.volume70en_US
dc.source.urihttps://www.japi.org/x2b46464/early-initiation-of-low-dose-hydrocortisone-therapy-for-septic-shock-in-geriatric-patients-a-randomized-control-trialen_US
dc.titleEarly Initiation of Low-Dose Hydrocortisone Therapy for Septic Shock in Geriatric Patients: A Randomized Control Trialen_US
dc.typeJournal Articleen_US
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