• Sarah J Atkinson, Natalie Z Cvijanovich, Neal J Thomas, Geoffrey L Allen, Nick Anas, Michael T Bigham, Mark Hall, Robert J Freishtat, Anita Sen, Keith Meyer, Paul A Checchia, Thomas P Shanley, Jeffrey Nowak, Michael Quasney, Scott L Weiss, Sharon Banschbach, Eileen Beckman, Kelli Howard, Erin Frank, Kelli Harmon, Patrick Lahni, Christopher J Lindsell, and Hector R Wong.
• Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, OH, United States of America; Department of Surgery, University of Cincinnati, Cincinnati, OH, United States of America.
• Plos One. 2014 Jan 1; 9 (11): e112702.

BackgroundThe potential benefits of corticosteroids for septic shock may depend on initial mortality risk.ObjectiveWe determined associations between corticosteroids and outcomes in children with septic shock who were stratified by initial mortality risk.MethodsWe 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.ResultsSubjects 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.ConclusionsRisk stratified analysis failed to demonstrate any benefit from corticosteroids in this pediatric septic shock cohort.

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