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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.

The George Institute for Global Health, Sydney, New South Wales, Australia. Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. Royal Brisbane Clinical Unit. The Wesley Hospital, Brisbane, Queensland, Australia. Austin Health, Melbourne, Victoria, Australia. Faculty of Medicine and. Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia. Diamantina Institute, and. Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom. Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia. Royal North Shore Hospital, Sydney, New South Wales, Australia. Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand. Pathology Queensland, Queensland, Australia. Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia. St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia. The Queen Elizabeth Hospital, Adelaide, South Australia, Australia. University of Adelaide, Adelaide, South Australia, Australia. Monash University, Melbourne, Victoria, Australia. St. George's Hospital, London, United Kingdom; and. Hudson Institute of Medical Research, Clayton, Victoria, Australia. The Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia.

American journal of respiratory and critical care medicine. 2020;(5):700-707
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Abstract

Rationale: Whether biomarkers can identify subgroups of patients with septic shock with differential treatment responses to hydrocortisone is unknown.Objectives: 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.Methods: From May 2014 to April 2017, we obtained serum samples from 529 patients with septic shock from 22 ICUs in Australia and New Zealand.Measurements and Main Results: There were no significant interactions between the association with 90-day mortality and treatment with either hydrocortisone or placebo for total cortisol (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.02-1.16 vs. OR, 1.07; 95% CI, 1.00-1.13; P = 0.70), free cortisol (OR, 1.20; 95% CI, 1.04-1.38 vs. OR, 1.16; 95% CI, 1.02-1.32; P = 0.75), aldosterone (OR, 1.01; 95% CI, 0.97-1.05 vs. OR, 1.01; 95% CI, 0.98-1.04; P = 0.99), or ascorbic acid (OR, 1.11; 95% CI, 0.89-1.39 vs. OR, 1.05; 95% CI, 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 (OR, 1.13; 95% CI, 1.00-1.27; P = 0.04), but total cortisol, aldosterone, and ascorbic acid were not.Conclusions: 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.

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