ĐÁNH GIÁ CẢI THIỆN HUYẾT ĐỘNG SAU ĐIỀU TRỊ HYDROCORTISONE Ở BỆNH NHÂN SỐC NHIỄM KHUẨN

Abstract

Background: Septic shock is a severe form of sepsis associated with high mortality and requires timely hemodynamic stabilization. In patients with persistent shock despite fluid resuscitation and vasopressor therapy, low-dose hydrocortisone may support hemodynamic improvement, although treatment response is heterogeneous. Objective: To evaluate hemodynamic improvement after hydrocortisone therapy and to analyze the association between baseline cortisol levels and hemodynamic improvement in patients with septic shock. Materials and methods: This descriptive cross-sectional study with follow-up included 62 patients with septic shock who received hydrocortisone therapy at the Intensive Care Unit, Kien Giang General Hospital from October 2022 to August 2023. Hemodynamic response was assessed using mean arterial pressure before and after treatment and the increase in MAP. Patients were stratified according to baseline cortisol levels of <20 µg/dL and ≥20 µg/dL. Results: The mean age was 65.68 ± 10.73 years, males and females each accounted for 50.0% of the study population. The mean SOFA score was 7.92 ± 1.97. The median baseline cortisol level was 17.67 µg/dL, with an interquartile range of 9.37–38.99 µg/dL. Patients with baseline cortisol ≥20 µg/dL had a higher SOFA score and lower baseline MAP than those with baseline cortisol <20 µg/dL (p <0.05). The increase in MAP was greater in the cortisol ≥20 µg/dL group than in the cortisol <20 µg/dL group with median values of 26.60 mmHg and 14.95 mmHg, respectively (p = 0.016). After adjustment for baseline MAP, SOFA score, blood lactate, and PaO₂/FiO₂, baseline cortisol ≥20 µg/dL remained associated with a greater increase in MAP (β = 7.41; 95% CI: 0.84– 13.98). Conclusion: In patients with septic shock treated with hydrocortisone, baseline cortisol ≥20 µg/dL may be associated with greater hemodynamic improvement after treatment.