Trajectories of mean arterial pressure/norepinephrine equivalent dose index in patients with septic shock receiving low-dose hydrocortisone: a retrospective cohort study in Thailand.

Abstract

Background: We aimed to analyze the trajectories of the mean arterial pressure/norepinephrine equivalent dose (MAP/NEQ) index in patients with septic shock treated with low-dose hydrocortisone and to determine the association of these trajectories with mortality.

Methods: A retrospective cohort of 203 patients with septic shock receiving low-dose hydrocortisone was examined. MAP and NEQ data were collected from electronic health records, and groupbased trajectory modeling was employed to identify distinct patterns in the MAP/NEQ index over the initial 72 hours of treatment. Univariable and multivariable logistic regression analyses were conducted to assess the associations of MAP/NEQ index trajectories with clinical variables and in-hospital mortality.

Results: The overall in-hospital mortality rate was 56.2%. Three MAP/NEQ index trajectory patterns were identified: unchanged (76.8%), gradually increased (14.3%), and rapidly increased (8.9%). The shock reversal rates were 50% for the unchanged group, 89.7% for the gradually increased group, and 100% for the rapidly increased group. Compared with the unchanged group, both gradually and rapidly increased groups were associated with significantly lower mortality, with adjusted odds ratios of 0.15 (95% CI, 0.05-0.40; P<0.001) and 0.29 (95% CI, 0.09-0.92; P=0.035), respectively.

Conclusions: In patients with septic shock treated with low-dose hydrocortisone, gradually and rapidly increased MAP/NEQ index trajectories were associated with significantly lower mortality risks and higher rates of shock reversal compared to those with unchanged trajectories. These findings highlight the importance of monitoring the MAP/NEQ index to guide treatment and improve septic shock outcomes.