Evaluation of early hydrocortisone use for hemodynamic shock in adult burn patients with suspected critical illness related corticosteroid insufficiency

Abstract

Critical illness-related corticosteroid insufficiency (CIRCI) presents as refractory hemodynamic shock in critically ill patients. Research on CIRCI and its treatment in burn patients is limited. We sought to review the use of corticosteroids in a burn population during their first week of hospitalization. The burn registry and the electronic medical records were queried for burn patients admitted between January 2015 and December 2025. The following variables were abstracted: demographics, burn history, hospital course, and treatments. Outcome variables included length of stay (LOS), infections, graft loss, pharmacological treatment, and mortality. The two groups were compared with Student’s T-test and Chi Square where appropriate. A multivariant analysis was performed to determine independent predictors of CIRCI, infection and mortality. Significance was determined at p<0.05 level.

The study group consisted of 87 patients in hemodynamic shock receiving vasopressors, with 47 also receiving corticosteroids. The corticosteroid group had larger burns (37.6 v 25.1%), more resuscitation (15.9 v 8.1 L), more vasopressor days (6.23 v 3.7 d), more ventilator days (19.72 v 7.83 d), more infections (66% v 34%) and longer LOS (51.53 v 26.05 d), all p<0.05. On multivariant analysis, variables independently related to the diagnosis of CIRCI were age and resuscitation fluids; to infection were corticosteroid use; and to mortality were age.

Overall, over 50% of patients in hypotensive shock during their first week of treatment were diagnosed and treated with corticosteroids for suspected CIRCI. More study is needed to determine the appropriate role of corticosteroid use in early burn treatment.