Low-Dose Corticosteroid Treatment in Septic Shock
Bibliographic record
Abstract
OBJECTIVE: Given conflicting data and current guidelines, low-dose corticosteroids are often used in the treatment of septic shock. To evaluate the therapeutic benefit of early low-dose corticosteroid in patients with septic shock. DESIGN: Retrospective, multicenter, propensity-matched cohort study. SETTING: ICUs of 28 academic and community hospitals in three countries between 1996 and 2007. SUBJECTS: Six thousand six hundred sixty-three eligible patients with septic shock of whom 1,838 received IV low-dose corticosteroid treatment within 48 hours of the diagnosis of septic shock and were matched to a comparable group who did not receive low-dose corticosteroid. MEASUREMENTS AND MAIN RESULTS: The primary outcome was 30-day mortality. Mortality analyses were stratified by severity of illness (Acute Physiology and Chronic Health Evaluation II quartile). Using a Cox proportional hazards model, corticosteroid therapy was associated with similar 30-day mortality when compared with the matched control cohort (652/1,838 [35.5%] vs 641/1,838 [34.9%]; hazard ratio, 0.98; 95% CI, 0.88-1.10; p = 0.77). In the subgroup of patients with the Acute Physiology and Chronic Health Evaluation II score quartile more than or equal to 30, low-dose corticosteroid was associated with lower mortality (232/461 [50.6%] vs 251/450 [55.8%]; hazard ratio, 0.81; 95% CI, 0.68-0.97; p = 0.02). In logistic regression models, corticosteroid therapy was not associated with reductions in ICU (556/1,838 [30.3%] vs 558/1,838 [30.4%]; odds ratio, 0.99; 95% CI, 0.86-1.15; p = 0.94) or hospital mortality (797/1,838 [43.4%] vs 773/1,838 [42.1%]; odds ratio, 1.05; 95% CI, 0.93-1.20; p = 0.42). Similarly, there were no significant differences in ventilator- (median and interquartile range, 13 [0-25] vs 15 [0-25]; p = 0.8) and pressor/inotrope-free days (median and interquartile range, 25 [3-27] vs 24 [2-28]; p = 0.63) up to 30 days between groups. CONCLUSION: Early administration of low-dose corticosteroid is not associated with decreased mortality when it is administered to unselected patients with septic shock. A beneficial effect of low-dose corticosteroid on mortality may exist in patients with the highest severity of illness. Future trials of low-dose corticosteroid in septic shock should consider restricting the study population to this cohort.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".