Comparison of Hydrocortisone Dosing Strategies in Septic Shock

Introduction: Septic shock is characterized by significant hemodynamic compromise and is associated with significant mortality. Relative adrenal insufficiency has been reported to occur in 50-60% of patients with septic shock and the addition of hydrocortisone is commonly used as an adjunctive therapy to help support underlying inflammatory responses and hemodynamics. The optimal dose for corticosteroid use in septic shock has yet to be determined, with differences in guideline recommendations and clinicians applying varying approaches to dosing strategies.


Methods: This retrospective study included adult patients with confirmed or suspected septic shock requiring vasopressors, initiated on corticosteroid therapy, and admitted to the medical intensive care unit from January 2021 to June 2024 at Penn State Hershey Medical Center. Patients were categorized into two dosing strategies: intravenous hydrocortisone 100mg q8h or 50mg q6h. Each group was evaluated for admission qSOFA scores, vasopressor requirements expressed in norepinephrine equivalence at hydrocortisone initiation and discontinuation, and duration of vasopressor and corticosteroid therapy were collected throughout ICU stay. Clinical outcomes were compared between the two groups including time to vasopressor discontinuation and rates of hyperglycemia.


Results: A total of 178 patients were included (n = 74, 50 mg q6h- and n = 104, 100 mg q8h, respectively). While not statistically significant, fewer instances of hyperglycemia were observed in the 50mg q6h cohort compared to the 100mg q8h cohort (41.9% vs. 44.4%, p =0.334). There were no differences in vasopressor duration, with both cohorts averaging 3 days of vasopressor therapy. There were no differences between groups regarding ICU length of stay or mortality.


Conclusions: In patients receiving hydrocortisone therapy for septic shock, neither dosing regimen showed superiority in time to vasopressor discontinuation, suggesting either regimen may be used effectively as adjunctive therapy. Fewer instances of hyperglycemia reported with the hydrocortisone 50 mg q6h regimen may suggest better glycemic control in septic shock patients.