Early administration of corticosteroids and mortality

Excerpt

We read the paper by Dr Park and colleagues [1] with interest. The evaluation of the association between the early administration of corticosteroids and mortality in patients with septic shock is extremely important. The authors demonstrated that the median time to steroid initiation was shorter in survivors and mortality rates increased with increasing quintiles of time until the initiation of steroids. The authors correctly note the limitations of their study given its retrospective design with the possibility of selection bias related to more severely ill patients receiving steroids later. As the baseline severity or number of organ failure at the time of steroid treatment was not different between the early and later treated patients and the adjusted multivariate analysis corrected for age, gender, time to initiation of antibiotics and illness severity (Simplified Acute Physiology Score (SAPS) 3) still showed a significant association between the time to initiation of steroid therapy and 28-day mortality, the authors concluded that there is a significant association between early steroid initiation and decreased mortality in septic shock patients. Unfortunately, the data for illness severity (SAPS3 and Sequential Organ Failure Assessment (SOFA) scores) as assessed by quintiles over time was not reported. These data according to the authors during the review process showed significant increases of SAPS3 (P < 0.01) and SOFA (P < 0.05) scores over time, which could also explain the increased mortality in patients receiving corticosteroids later. Therefore, the findings of increased mortality in patients receiving steroids later could be related to the initiation time of the steroids or alternatively to their increased severity of illness. …