Impact of sex on outcomes in septic shock patients treated with hydrocortisone

Abstract

Limited evidence exists regarding the influence of sex on the prognosis of patients with persistent septic shock following hydrocortisone treatment. This study aimed to examine sex-related differences in hydrocortisone treatment outcomes among critically ill patients with persistent septic shock. This is a retrospective cohort study conducted over 12 months, including critically ill adult patients who were admitted with persistent septic shock and were on vasopressors while receiving hydrocortisone. The primary outcome was twenty-eight-day mortality. The secondary outcomes included vasopressor support duration, intensive care unit (ICU) stay, hospital stay, renal replacement therapy (RRT) requirement, mechanical ventilation (MV) requirement, and seven-day mortality. In total, 621 patients were analyzed; of these, 59.3% were male. Male sex was linked to an elevated 28-day mortality risk according to univariate analysis (OR 1.543, 95% CI 1.112-2.141; p = 0.009) and multivariate adjustment (OR 1.604, 95% CI 1.142-2.253; p = 0.006). According to the Kaplan-Meier curves, a significant difference in 28-day mortality (p = 0.008) was observed, with females exhibiting consistently higher cumulative survival rates. The initial analysis of secondary outcomes showed no differences, except for the requirement of renal replacement therapy (RRT); however, this association did not remain significant in multivariate analysis. This study underscores significant sex differences in the outcomes of patients with persistent septic shock treated with hydrocortisone, with males exhibiting higher 28-day mortality than females. In all measured secondary outcomes, no significant differences were detected.Trial registration: This investigation was registered on clinicaltrials.gov (NCT06537180, study ID: GBD-HYDRO, 31 July 2024).