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Title: Plasma Cortisol, Aldosterone, and Ascorbic Acid Concentrations in Patients with Septic Shock do not Predict Treatment Effect of Hydrocortisone on Mortality: A Nested Cohort Study.
Austin Authors: Cohen, Jeremy;Bellomo, Rinaldo ;Billot, Laurent;Burrell, Louise M ;Evans, David M;Finfer, Simon;Hammond, Naomi E;Li, Qiang;Liu, David Shi Hao ;McArthur, Colin;McWhinney, Brett;Moore, John;Myburgh, John;Peake, Sandra;Pretorius, Carel;Rajbhandari, Dorrilyn;Rhodes, Andrew;Saxena, Manoj;Ungerer, Jacobus Pj;Young, Morag J;Venkatesh, Balasubramanian
Affiliation: University of New South Wales, St George Clinical School, Sydney, New South Wales, Australia
The University of Adelaide, 1066, Adelaide, South Australia, Australia
Monash University, 2541, Clayton, Victoria, Australia
Pathology Queensland, Department of Chemical Pathology, Brisbane, Queensland, Australia
Hudson Institute of Medical Research, 518514, Clayton, Victoria, Australia
Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Austin Health, Heidelberg, Victoria, Australia
George Institute for Global Health, 211065, Sydney, New South Wales, Australia
Translational Research Institute Australia, 373031, South Brisbane, Queensland, Australia
University of Bristol, 1980, Medical Research Council Integrative Epidemiology Unit, Bristol, United Kingdom of Great Britain and Northern Ireland
University of Sydney, Intensive Care, St. Leonards, New South Wales, Australia
Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
Health Support Queensland Pathology Queensland, 139306, Herston, Queensland, Australia
Sunshine Coast University College, 5333, Maroochydore DC, Queensland, Australia
Auckland City Hospital, Intensive Care, Auckland, New Zealand
St Georges Hospital, London, United Kingdom of Great Britain and Northern Ireland
Issue Date: 1-Sep-2020 2020-05-12
Publication information: American Journal of Respiratory and Critical Care Medicine 2020; 202(5): 700-707
Abstract: Whether biomarkers can identify subgroups of patients with septic shock with differential treatment responses to hydrocortisone is unknown. To determine if there is heterogeneity in effect for hydrocortisone on mortality, shock resolution and other clinical outcomes based on baseline cortisol, aldosterone and ascorbic acid concentrations. From May 2014 to April 2017, we obtained serum samples from 529 patients with septic shock from 22 intensive care units in Australia and New Zealand. There were no significant interactions between the association with 90-day mortality and treatment with either hydrocortisone or placebo for total cortisol (odds ratio 1.09, 95% confidence interval 1.02-1.16, vs odds ratio 1.07, 95% confidence interval 1.00-1.13, p=0.70), free cortisol (odds ratio 1.20, 95% confidence interval 1.04-1.38 vs odds ratio 1.16, 95% confidence interval 1.02-1.32, p=0.75), aldosterone (odds ratio 1.01, 95% confidence interval 0.97-1.05, vs odds ratio 1.01, 95% confidence interval 0.98-1.04, p=0.99), or ascorbic acid (odds ratio 1.11, 95% confidence interval 0.89-1.39 vs odds ratio 1.05, 95% confidence interval 0.91-1.22, p=0.70) respectively. Similar results were observed for the association with shock resolution. Elevated free cortisol was significantly associated with 90-day mortality (odds ratio 1.13, 95% confidence interval 1.00-1.27, p=0.04) but total cortisol, aldosterone and ascorbic acid were not. In patients with septic shock, there was no heterogeneity in effect of adjunctive hydrocortisone on mortality, shock resolution or other clinical outcomes based on cortisol, aldosterone and ascorbic acid concentrations. Plasma aldosterone and ascorbic acid concentrations are not associated with outcome.
DOI: 10.1164/rccm.202002-0281OC
ORCID: 0000-0003-1863-7539
PubMed URL: 32396775
Type: Journal Article
Subjects: Aldosterone
Ascorbic Acid
Septic Shock
Appears in Collections:Journal articles

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