dc.creator | Mentzelopoulos S.D., Koliantzaki I., Karvouniaris M., Vrettou C., Mongardon N., Karlis G., Makris D., Zakynthinos E., Sourlas S., Aloizos S., Xanthos T., Zakynthinos S.G. | en |
dc.date.accessioned | 2023-01-31T08:59:11Z | |
dc.date.available | 2023-01-31T08:59:11Z | |
dc.date.issued | 2018 | |
dc.identifier | 10.1007/s10557-018-6811-0 | |
dc.identifier.issn | 09203206 | |
dc.identifier.uri | http://hdl.handle.net/11615/76549 | |
dc.description.abstract | Purpose: Low-dose steroids may reduce the mortality of severely ill patients with septic shock. We sought to determine whether exposure to stress-dose steroids during and/or after cardiopulmonary resuscitation is associated with reduced risk of death due to postresuscitation septic shock. Methods: We analyzed pooled, individual patient data from two prior, randomized clinical trials (RCTs). RCTs evaluated vasopressin, steroids, and epinephrine (VSE) during resuscitation and stress-dose steroids after resuscitation in vasopressor-requiring, in-hospital cardiac arrest. In the second RCT, 15 control group patients received open-label, stress-dose steroids. Patients with postresuscitation shock were assigned to a Steroids (n = 118) or No Steroids (n = 73) group according to an “as-treated” principle. We used cumulative incidence competing risks Cox regression to determine cause-specific hazard ratios (CSHRs) for pre-specified predictors of lethal septic shock (primary outcome). In sensitivity analyses, data were analyzed according to the intention-to-treat (ITT) principle (VSE group, n = 103; control group, n = 88). Results: Lethal septic shock was less likely in Steroids versus No Steroids group, CSHR, 0.40, 95% confidence interval (CI), 0.20–0.82; p = 0.012. ITT analysis yielded similar results: VSE versus Control, CSHR, 0.44, 95% CI, 0.23–0.87; p = 0.019. Adjustment for significant, between-group baseline differences in composite cardiac arrest causes such as “hypotension and/or myocardial ischemia” did not appreciably affect the aforementioned CSHRs. Conclusions: In this reanalysis, exposure to stress-dose steroids (primarily in the context of a combined VSE intervention) was associated with lower risk of postresuscitation lethal septic shock. © 2018, Springer Science+Business Media, LLC, part of Springer Nature. | en |
dc.language.iso | en | en |
dc.source | Cardiovascular Drugs and Therapy | en |
dc.source.uri | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85051699282&doi=10.1007%2fs10557-018-6811-0&partnerID=40&md5=a54fe13711a305521975121092a8d97a | |
dc.subject | antiarrhythmic agent | en |
dc.subject | epinephrine | en |
dc.subject | hydrocortisone | en |
dc.subject | insulin | en |
dc.subject | methylprednisolone | en |
dc.subject | vasopressin | en |
dc.subject | epinephrine | en |
dc.subject | steroid | en |
dc.subject | vasopressin derivative | en |
dc.subject | adult | en |
dc.subject | aged | en |
dc.subject | antibiotic resistance | en |
dc.subject | antibiotic therapy | en |
dc.subject | Article | en |
dc.subject | comparative effectiveness | en |
dc.subject | controlled study | en |
dc.subject | data analysis | en |
dc.subject | drug use | en |
dc.subject | female | en |
dc.subject | follow up | en |
dc.subject | heart arrest | en |
dc.subject | human | en |
dc.subject | hyperglycemia | en |
dc.subject | in hospital cardiac arrest | en |
dc.subject | ischemia | en |
dc.subject | major clinical study | en |
dc.subject | male | en |
dc.subject | patient information | en |
dc.subject | priority journal | en |
dc.subject | randomized controlled trial (topic) | en |
dc.subject | resuscitation | en |
dc.subject | septic shock | en |
dc.subject | Sequential Organ Failure Assessment Score | en |
dc.subject | steroid therapy | en |
dc.subject | drug combination | en |
dc.subject | heart arrest | en |
dc.subject | hospital admission | en |
dc.subject | microbiology | en |
dc.subject | middle aged | en |
dc.subject | mortality | en |
dc.subject | pathophysiology | en |
dc.subject | protection | en |
dc.subject | resuscitation | en |
dc.subject | retrospective study | en |
dc.subject | risk factor | en |
dc.subject | septic shock | en |
dc.subject | time factor | en |
dc.subject | treatment outcome | en |
dc.subject | Aged | en |
dc.subject | Cardiopulmonary Resuscitation | en |
dc.subject | Drug Combinations | en |
dc.subject | Epinephrine | en |
dc.subject | Female | en |
dc.subject | Heart Arrest | en |
dc.subject | Humans | en |
dc.subject | Male | en |
dc.subject | Middle Aged | en |
dc.subject | Patient Admission | en |
dc.subject | Protective Factors | en |
dc.subject | Randomized Controlled Trials as Topic | en |
dc.subject | Retrospective Studies | en |
dc.subject | Risk Factors | en |
dc.subject | Shock, Septic | en |
dc.subject | Steroids | en |
dc.subject | Time Factors | en |
dc.subject | Treatment Outcome | en |
dc.subject | Vasopressins | en |
dc.subject | Springer New York LLC | en |
dc.title | Exposure to Stress-Dose Steroids and Lethal Septic Shock After In-Hospital Cardiac Arrest: Individual Patient Data Reanalysis of Two Prior Randomized Clinical Trials that Evaluated the Vasopressin–Steroids–Epinephrine Combination Versus Epinephrine Alone | en |
dc.type | journalArticle | en |