Clinical effect of hydrocortisone on early sepsis-related acute respiratory distress syndrome

Fang Ge; Song Genhong; Lin Xiaoyan

doi:10.3760/cma.j.issn.1673-4777.2017.12.016

Abstract：Objective To analyze the clinical effect of hydrocortisone on early sepsis-related acute respiratory distress syndrome (ARDS).Methods Totally 80 patients with early sepsis-related ARDS were enrolled in Yan'an University Affiliated Hospital from January 2010 to December 2015;they were equally allocated to have hydrocortisone(50 mg/time,1 time/6 h,for 7 d) and placebo(0.9％ sodium chloride).Oxygenation index,score of lung injury and death were recorded.Influence factors of 28 d survival rate were analyzed by logistic regression.Adverse reactions were observed.Results Tidal volume in hydrocortisone group was significantly lower than that in placebo group (P =0.04);other basic clinical data had no significant differences between groups (P ＞ 0.05).Oxygenation index in hydrocortisone group was significantly higher and score of lung injury was significantly lower than that in placebo group 1-7 d and 14 d after treatment[1 d:(226 ± 12)mmHg vs (192 ± 11)mmHg,(1.82 ±0.23) points vs (2.26 ±0.65) points;7 d:(313 ± 15) mmHg vs (289 ± 15) mmHg,(1.03±0.06)points vs (1.35 ±0.09)points;14 d:(332 ± 14)mmHg vs (305 ± 16)mmHg,(0.92 ± 0.04)points vs (1.22 ± 0.12)points] (P ＜ 0.05).Death rate and adverse reaction rate had no significant differences between groups(P ＞0.05).Logistic regression analysis showed that score of the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) was a risk factor of 28 d survival rate in patients with early sepsis-related ARDS(P ＜0.05);hydrocortisone had no protective effect on 28 d survival(P ＞0.05).Conclusions Hydrocortisone treating early sepsis-related ARDS can improve oxygenation index and reduce lung injury but not increase survival rate.The APACHE Ⅱ score is an influence factor of 28 d survival rate in patients with sepsis-related ARDS.