Hydrocortisone Dosing Frequency in Septic Shock

Introduction: We sought to determine if there are any differences in clinical outcomes between hydrocortisone dosing regimens for septic shock.


Methods: This was a retrospective, observational cohort study evaluating hydrocortisone 50 mg intravenously (IV) every 6 hours compared to hydrocortisone 100 mg IV every 12 hours in critically ill patients with septic shock admitted to a 3-hospital health system during a national hydrocortisone shortage. The primary endpoint was time to reversal of septic shock, defined as the maintenance of a systolic blood pressure of > 90 mm Hg without vasopressor support for >24 hours.


Results: Among the 89 patients included in this study, 59 received hydrocortisone 50 mg every 6 hours and 30 received hydrocortisone 100 mg every 12 hours. The median SOFA score upon first dose of hydrocortisone was 11 [IQR 9, 13.5] and median norepinephrine equivalents were 0.425 mcg/kg/min [IQR 0.2, 0.623]. The duration of shock, in days, in the 50 mg every 6 hours group was a median of 3.07 [IQR 2.24, 4.24] versus 3.62 [IQR 3.07, 5.56] in the hydrocortisone 100 mg every 12 hours group. The hydrocortisone dosing regimen was not associated with a significant difference in time to reversal of shock, hospital or ICU length of stay, or various mortality endpoints.


Conclusions: In this retrospective analysis, there were no significant differences in time to reversal of shock, mortality, or length of stay. Based on these findings, hydrocortisone 100 mg IV every 12 hours may be considered during another shortage, pending further studies.