Open AccessExternal Corroboration That Corticosteroids May Be Harmful to Septic Shock Endotype A Patients
Author(s) -
Hector R. Wong,
Kimberly W. Hart,
Christopher J. Lindsell,
Timothy E. Sweeney
Publication year - 2020
Publication title -
critical care medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.002
H-Index - 271
eISSN - 1530-0293
pISSN - 0090-3493
DOI - 10.1097/ccm.0000000000004709
Subject(s) - medicine , septic shock , vasopressin , placebo , hydrocortisone , shock (circulatory) , endotype , randomized controlled trial , anesthesia , sepsis , pathology , asthma , alternative medicine
We previously reported gene expression-based endotypes of pediatric septic shock, endotypes A and B, and that corticosteroid exposure was independently associated with increased mortality among pediatric endotype A patients. The Vasopressin vs Norepinephrine as Initial Therapy in Septic Shock trial tested the efficacy of vasopressin as initial vasopressor therapy for septic shock among adult patients, when compared with norepinephrine. Patients who reached a prespecified dose of either vasopressor were further randomized to receive hydrocortisone or placebo. A proportion of patients in the Vasopressin vs Norepinephrine as Initial Therapy in Septic Shock trial had transcriptomic data generated at baseline using whole blood-derived messenger RNA. We used the publicly available transcriptomic data from the Vasopressin vs Norepinephrine as Initial Therapy in Septic Shock trial to assign the study subjects to pediatric septic shock endotype A or B, and tested the hypothesis that hydrocortisone treatment is associated with increased mortality among patients in endotype A.