34-The Effect of Early Corticosteroid Therapy on Outcomes in Children With Septic Shock
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Pediatrics, Sepsis, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Nicole Kamps


Introduction/Hypothesis: Corticosteroids are commonly used in the treatment of pediatric septic shock without clear evidence of the impact on mortality and morbidity. This study examined the effect of early corticosteroid therapy on the following outcomes in children hospitalized for septic shock: duration of vasoactive-inotropic support (VIS), survival (short-term, without new morbidity), health-related quality of life at month 1, ventilator, hospital and PICU-free days, and severity and duration of organ failure in the PICU.

Methods: This was a retrospective cohort analysis of data obtained from the prospective, descriptive Life After Pediatric Sepsis Evaluation (LAPSE) study that was conducted 2013-2017 across 12 US academic PICUs and included children with community-acquired septic shock requiring VIS and PICU admission. Patients were excluded if they were immunocompromised due to chronic corticosteroid use or if there was no reasonable chance that they would or would not receive corticosteroid therapy (institution standard of care, first day PELOD-2 score of 0, or first day VIS score >60). Outcomes in those who received either hydrocortisone or methylprednisolone on study days 0-3 were compared to those who did not using a propensity score-weighted analysis that controlled for age, sex, study site, and first day PRISM-IV, PELOD-2, and VIS scores.

Results: 323/392 children met inclusion criteria. 150/323 received early corticosteroid therapy. The two groups were successfully balanced based on subjects' propensity scores with an absolute standardized difference of <0.10 for the potentially confounding variables detailed above. No statistically significant differences between the groups were detected for any of the outcome measures.

Conclusions: This is the first study to examine the effect of early corticosteroid therapy on mortality and morbidity among children with septic shock. After adjusting for variables with the potential to confound the relationship between early corticosteroid therapy and clinically meaningful endpoints, there was no improvement in outcomes with this therapy. Results from this propensity analysis justify clinical equipoise regarding corticosteroids for pediatric septic shock, and ascertain the need for a well-designed clinical trial to rigorously examine benefit/risk for this intervention.


Meta Tag
Content Type Presentation
Knowledge Area Pediatrics
Knowledge Area Sepsis
Knowledge Level Advanced
Membership Level Select
Tag Shock
Tag Inflammation
Year 2021
corticosteroid therapy
septic shock
morbidity outcomes
pediatric patients
previous studies


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