HYDROCORTISONE IN SEPTIC SHOCK: A CROSS SECTIONAL STUDY ON VASOPRESSOR REQUIREMENTS & HEMODYNAMIC STABILITY

Abstract

Background: Septic shock is a critical condition marked by persistent hypotension, tissue hypoperfusion, and the need for vasopressors despite adequate fluid resuscitation. Hydrocortisone is commonly used when shock remains refractory, as it may improve vascular responsiveness and reduce catecholamine exposure. However, local evidence regarding its effect on vasopressor requirements and early ICU outcomes remains limited, particularly in public-sector tertiary-care settings where septic shock burden is high and resources are often constrained.

Objective: To evaluate changes in mean arterial pressure and norepinephrine-equivalent vasopressor requirements after intravenous hydrocortisone administration and to assess the association of early hemodynamic stability with ICU outcomes among adults with septic shock.

Methods: This prospective observational cohort study was conducted in the Medical ICU of Jinnah Postgraduate Medical Centre, Karachi, over six months after IRB approval. Adult patients aged 18–60 years with septic shock who received vasopressor support and intravenous hydrocortisone were enrolled using non-probability consecutive sampling. Hydrocortisone was administered as 50 mg intravenously every six hours. Mean arterial pressure and norepinephrine-equivalent vasopressor dose were recorded at hydrocortisone initiation and at 6, 12, 24, and 48 hours. Outcomes included hemodynamic stability, shock reversal, ICU mortality, and ventilator dependency beyond day 7. Data were analyzed using SPSS version 25, and p<0.05 was considered statistically significant.

Results: A total of 62 patients were included, with a mean age of 44.6±9.8 years. Males accounted for 59.7% of cases. Pneumonia was the most common source of sepsis, reported in 41.9% of patients. Mean arterial pressure increased from 58.3±6.1 mmHg at initiation to 68.7±5.4 mmHg at 24 hours and 70.4±5.0 mmHg at 48 hours (p<0.001). Norepinephrine-equivalent dose decreased from 0.42±0.11 mcg/kg/min to 0.19±0.08 mcg/kg/min at 24 hours and 0.11±0.06 mcg/kg/min at 48 hours (p<0.001). Hemodynamic stability at 24 hours was achieved in 66.1% of patients. Shock reversal occurred in 64.5%, ICU mortality was 27.4%, and ventilator dependency beyond day 7 was 21.0%. Stability at 24 hours was significantly associated with higher shock reversal (p<0.001) and lower ICU mortality (p=0.045).

Conclusion: Septic shock patients receiving intravenous hydrocortisone showed improved mean arterial pressure and reduced vasopressor requirements during early ICU monitoring. Hemodynamic stability within 24 hours was associated with better early ICU outcomes. Larger controlled studies are required to clarify the independent effect and safety profile of hydrocortisone in local ICU settings.

Keywords: Critical Care; Hemodynamics; Hydrocortisone; Intensive Care Units; Norepinephrine; Septic Shock; Vasoconstrictor Agents.