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Multicenter Study
. 2014 Nov 11;9(11):e112702.
doi: 10.1371/journal.pone.0112702. eCollection 2014.

Corticosteroids and pediatric septic shock outcomes: a risk stratified analysis

Sarah J Atkinson  1 , Natalie Z Cvijanovich  2 , Neal J Thomas  3 , Geoffrey L Allen  4 , Nick Anas  5 , Michael T Bigham  6 , Mark Hall  7 , Robert J Freishtat  8 , Anita Sen  9 , Keith Meyer  10 , Paul A Checchia  11 , Thomas P Shanley  12 , Jeffrey Nowak  13 , Michael Quasney  12 , Scott L Weiss  14 , Sharon Banschbach  15 , Eileen Beckman  15 , Kelli Howard  15 , Erin Frank  15 , Kelli Harmon  15 , Patrick Lahni  15 , Christopher J Lindsell  16 , Hector R Wong  17
Affiliations
Multicenter Study

Corticosteroids and pediatric septic shock outcomes: a risk stratified analysis

Sarah J Atkinson et al. PLoS One. .

Abstract

Background: The potential benefits of corticosteroids for septic shock may depend on initial mortality risk.

Objective: We determined associations between corticosteroids and outcomes in children with septic shock who were stratified by initial mortality risk.

Methods: We conducted a retrospective analysis of an ongoing, multi-center pediatric septic shock clinical and biological database. Using a validated biomarker-based stratification tool (PERSEVERE), 496 subjects were stratified into three initial mortality risk strata (low, intermediate, and high). Subjects receiving corticosteroids during the initial 7 days of admission (n = 252) were compared to subjects who did not receive corticosteroids (n = 244). Logistic regression was used to model the effects of corticosteroids on 28-day mortality and complicated course, defined as death within 28 days or persistence of two or more organ failures at 7 days.

Results: Subjects who received corticosteroids had greater organ failure burden, higher illness severity, higher mortality, and a greater requirement for vasoactive medications, compared to subjects who did not receive corticosteroids. PERSEVERE-based mortality risk did not differ between the two groups. For the entire cohort, corticosteroids were associated with increased risk of mortality (OR 2.3, 95% CI 1.3-4.0, p = 0.004) and a complicated course (OR 1.7, 95% CI 1.1-2.5, p = 0.012). Within each PERSEVERE-based stratum, corticosteroid administration was not associated with improved outcomes. Similarly, corticosteroid administration was not associated with improved outcomes among patients with no comorbidities, nor in groups of patients stratified by PRISM.

Conclusions: Risk stratified analysis failed to demonstrate any benefit from corticosteroids in this pediatric septic shock cohort.

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Conflict of interest statement

Competing Interests: Dr. Wong and the Cincinnati Children’s Hospital Research Foundation have submitted a provisional patent application for PERSEVERE. PCT/US2013/025233 (published 8/15/13 as WO 2013/119871), entitled “Biomarkers of Septic Shock”, filed 2/7/13 and claiming priority to U.S. Provisional application 61/595,996, filed 2/7/12. Dr. Lindsell is named as a co-inventor in the above patent application. The remaining authors have no competing interests to report. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

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