PSHP 2026 Residency Conference

Purpose: To evaluate whether an alternative hydrocortisone (HC) dosing regimen used during a national shortage, 100 mg IV every 8 hours (q8h), provides comparable clinical outcomes to the standard regimen, 50 mg IV every 6 hours (q6h), in the management of septic shock in adult patients.  


Methods: This single-center, retrospective cohort study included adults treated for septic shock in intensive care units. Patients were included if they received HC 50 mg IV q6h (5/21/2022–9/9/2022) or HC 100 mg IV q8h (5/21/2023–9/9/2023), had suspected infection, met ≥2 SIRS criteria, required vasopressors for >4 hours, and received ≥200 mg of the HC regimen of interest. Exclusion criteria included pregnancy or breastfeeding, vasopressor initiation at an outside hospital, or receipt of >200 mg daily hydrocortisone for indications other than septic shock. The primary outcome was time to shock reversal, defined as discontinuation of vasopressors for ≥24 hours. Secondary outcomes included mortality (in-hospital, 28-day, 90-day), ICU length of stay, duration of mechanical ventilation, and hyperglycemia. Descriptive statistics were used to describe baseline characteristics. Outcomes were analyzed using the Mann–Whitney U and chi-square tests. 


Results: Of 290 screened patients, 121 were included (50 mg q6h, n=35; 100 mg q8h, n=86). Baseline characteristics, illness severity, and vasopressor use were similar between groups. Shock reversal occurred in 51.4% of patients receiving 50 mg q6h and 54.7% receiving 100 mg q8h (p=0.747). Median time to shock reversal was 84.0 hours (IQR 46.3–145.0) versus 72.5 hours (IQR 46.2–136.8), respectively (p=0.769). There were no significant differences in mortality, ICU length of stay, duration of mechanical ventilation, or hyperglycemia between groups. 


Conclusion: This single-center, retrospective cohort study showed that the alternative dosing strategy of HC 100 mg q8h demonstrated similar clinical outcomes compared to the standard regimen of HC 50 mg q6h in patients with septic shock. Future prospective, randomized trials are needed to confirm findings.