Effect of fixed-dose hydrocortisone on vasopressor dose and mean arterial pressure in obese and nonobese patients with septic shock

Purpose: Several studies have shown hydrocortisone to be beneficial in the treatment of vasopressor-refractory septic shock, but there are minimal data evaluating the efficacy of this fixed dosing regimen in overweight and obese patients. The purpose of this study was to compare the effects of fixed-dose hydrocortisone on vasopressor dose and mean arterial pressure in obese and nonobese patients with septic shock refractory to adequate fluid resuscitation and vasopressor administration. Methods: In this multicenter, retrospective study, we included adult patients with a confirmed or suspected diagnosis of septic shock who received hydrocortisone (200 mg/day). Patients were divided into 4 study groups based on admission body mass index (BMI; defined as BMI of <25 kg/m2, 25-29.9 kg/m2, 30-34.9 kg/m2, and ≥35 kg/m2). The primary outcomes analyzed were change in norepinephrine equivalent dose requirements and mean arterial pressure (MAP) at 6, 12, and 24 hours after initiating hydrocortisone. Results: Between October 1, 2017, and September 30, 2020, 431 patients were screened of whom 219 met inclusion criteria. Baseline characteristics were comparable among the groups. Mean vasopressor requirements (in μg/min) at 6, 12, and 24 hours were as follows: BMI of <25 kg/m2: 28.8, 24.8, and 20; BMI of 25-29.9 kg/m2: 34.1, 33.5, and 24.8; BMI of 30-34.9 kg/m2: 29.5, 33.5, and 24.8; and BMI of ≥35 kg/m2: 32, 25.7 and, 21.2 (P = 0.75, 0.41, and 0.61, respectively). Mean MAP (in mm Hg) at 6, 12, and 24 hours was as follows: BMI of <25 kg/m2: 73.5, 73.6, and 74; BMI of 25-29.9 kg/m2: 71.6, 73.8, and 71.9; BMI of 30-34.9 kg/m2: 72.2, 70, and 72.7; and BMI of ≥35 kg/m2: 70.7, 73.5, and 71.4 (P = 0.56, 0.15, and 0.62, respectively). Conclusion: BMI does not appear to impact the effects of fixed-dose hydrocortisone on vasopressor dose or blood pressure in patients with septic shock. Fixed-dose hydrocortisone should continue to be used for vasopressor-refractory septic shock in obese patients.