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Peer-reviewedCC BY 4.0PLOS One

Association between hydrocortisone use and outcomes in sepsis patients with hospital-acquired bloodstream infections: An ancillary analysis of the EUROBACT-2 cohort

  • Gary Duclos1
  • Mohamed Boucekine2
  • Alexis Tabah3
  • Stéphane Ruckly4
  • Niccolò Buetti5
  • Jean François Timsit6
  • Marc Leone7
  • EUROBACT-2 Study Group8
  • ESICM9
  • ESCMID ESGCIP10
  • the OUTCOMEREA Network11
11 affiliations
  1. 1Department of Anesthesiology and Intensive Care Unit, Hospital Nord, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France
  2. 2Centre d’Etudes et de Recherches sur les services de santé et qualité de vie EA 3279, Aix Marseille Université, Marseille, France
  3. 3Intensive Care Unit, Redcliffe Hospital, Brisbane, Australia
  4. 4Queensland University of Technology, Brisbane, Queensland, Australia
  5. 5Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  6. 6Université de Paris, INSERM, IAME UMR 1137, Paris, France
  7. 7ICUREsearch, Biometry, Fontaine, France
  8. 8Infection Antimicrobials Modeling Evolution U 1137, INSERM, Université Paris-Cité, Paris, France
  9. 9Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
  10. 10Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, Paris, France
  11. 11OUTCOME REA network, Drancy, France
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Abstract

Purpose: Corticosteroids are suggested for selected patients with septic shock, but their association with outcomes has not been specifically investigated in patients with hospital-acquired bloodstream infections (HA-BSI). We explored the association between hydrocortisone use and day-28 mortality in this population. Methods: Data from the prospective EUROBACT-2 study were used to assess the association between hydrocortisone use and day-28 mortality in ICU patients with HA-BSI and sepsis. Patients receiving hydrocortisone were compared with patients not receiving hydrocortisone. A 1:1 propensity score matching procedure was performed using nearest-neighbour matching without replacement and a caliper of 0.2 standard deviation of the logit propensity score, followed by multivariable logistic regression with cluster-robust standard errors by matched pair. Results: Among 2,401 analyzed patients, 608 (25%) received hydrocortisone during the HA-BSI episode. The final propensity score included age, sex, Charlson comorbidity score, ICU admission diagnosis, SOFA score without cardiovascular component, septic shock, country of inclusion, lactate at HA-BSI diagnosis, and ICU-acquired versus non-ICU-acquired HA-BSI. Matching yielded 521 pairs (1,042 patients). In the multivariable model, hydrocortisone use was associated with increased day-28 mortality in the overall matched cohort (OR 1.448; 95% CI 1.096–1.914; p = 0.009). This association was observed in patients with sepsis without shock (OR 1.697; 95% CI 1.051–2.740; p = 0.031) and in the female subgroup (OR 1.718; 95% CI 1.055–2.796; p = 0.030), but not in patients with septic shock or in those receiving norepinephrine-equivalent dose ≥0.25 µg/kg/min. Conclusion: Hydrocortisone use was not associated with improved day-28 survival in ICU patients with HA-BSI. In the matched analysis, hydrocortisone use was associated with higher day-28 mortality in the overall cohort, whereas no significant association was observed in patients with septic shock or high-dose norepinephrine. These findings are observational and hypothesis-generating and should not be interpreted causally.

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Cite

BibTeXRIS
BibTeX
@article{duclos2026association,
  title = {{Association between hydrocortisone use and outcomes in sepsis patients with hospital-acquired bloodstream infections: An ancillary analysis of the EUROBACT-2 cohort}},
  author = {Gary Duclos and Mohamed Boucekine and Alexis Tabah and Stéphane Ruckly and Niccolò Buetti and Jean François Timsit and Marc Leone and EUROBACT-2 Study Group and ESICM and ESCMID ESGCIP and the OUTCOMEREA Network},
  journal = {PLOS One},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pone.0356721},
  url = {https://doi.org/10.1371/journal.pone.0356721},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Association between hydrocortisone use and outcomes in sepsis patients with hospital-acquired bloodstream infections: An ancillary analysis of the EUROBACT-2 cohort
AU  - Gary Duclos
AU  - Mohamed Boucekine
AU  - Alexis Tabah
AU  - Stéphane Ruckly
AU  - Niccolò Buetti
AU  - Jean François Timsit
AU  - Marc Leone
AU  - EUROBACT-2 Study Group
AU  - ESICM
AU  - ESCMID ESGCIP
AU  - the OUTCOMEREA Network
PY  - 2026
DA  - 2026/09/15
JO  - PLOS One
DO  - 10.1371/journal.pone.0356721
UR  - https://doi.org/10.1371/journal.pone.0356721
AB  - Purpose: Corticosteroids are suggested for selected patients with septic shock, but their association with outcomes has not been specifically investigated in patients with hospital-acquired bloodstream infections (HA-BSI). We explored the association between hydrocortisone use and day-28 mortality in this population. Methods: Data from the prospective EUROBACT-2 study were used to assess the association between hydrocortisone use and day-28 mortality in ICU patients with HA-BSI and sepsis. Patients receiving hydrocortisone were compared with patients not receiving hydrocortisone. A 1:1 propensity score matching procedure was performed using nearest-neighbour matching without replacement and a caliper of 0.2 standard deviation of the logit propensity score, followed by multivariable logistic regression with cluster-robust standard errors by matched pair. Results: Among 2,401 analyzed patients, 608 (25%) received hydrocortisone during the HA-BSI episode. The final propensity score included age, sex, Charlson comorbidity score, ICU admission diagnosis, SOFA score without cardiovascular component, septic shock, country of inclusion, lactate at HA-BSI diagnosis, and ICU-acquired versus non-ICU-acquired HA-BSI. Matching yielded 521 pairs (1,042 patients). In the multivariable model, hydrocortisone use was associated with increased day-28 mortality in the overall matched cohort (OR 1.448; 95% CI 1.096–1.914; p = 0.009). This association was observed in patients with sepsis without shock (OR 1.697; 95% CI 1.051–2.740; p = 0.031) and in the female subgroup (OR 1.718; 95% CI 1.055–2.796; p = 0.030), but not in patients with septic shock or in those receiving norepinephrine-equivalent dose ≥0.25 µg/kg/min. Conclusion: Hydrocortisone use was not associated with improved day-28 survival in ICU patients with HA-BSI. In the matched analysis, hydrocortisone use was associated with higher day-28 mortality in the overall cohort, whereas no significant association was observed in patients with septic shock or high-dose norepinephrine. These findings are observational and hypothesis-generating and should not be interpreted causally.
SN  - 1932-6203
ER  -