2026 Southeastern Residency Conference

Background:
Sepsis is a life-threatening condition caused by a dysregulated host response to infection, and septic shock represents its most severe form, carrying a high mortality risk. Intravenous (IV) hydrocortisone is recommended by the Surviving Sepsis Guidelines for patients requiring ongoing vasopressor support despite adequate fluid resuscitation. However, the optimal discontinuation strategy remains unclear as current guidelines do not specify whether hydrocortisone should be tapered or abruptly discontinued. Existing literature is limited and conflicting, and practice variability persists. This study evaluates the impact of hydrocortisone tapering versus abrupt discontinuation on recurrence of septic shock.
Methods:
This single-center, retrospective cohort study was conducted at Atrium Health Wake Forest Baptist Medical Center. Adult patients admitted to the Medical Intensive Care Unit (ICU) between September 2024 and August 2025 who received ≥ 8 doses or ≥48 hours of IV hydrocortisone for septic shock were included. Patients were categorized into two groups: taper (any dose reduction prior to discontinuation) or no taper (abrupt discontinuation). Resolution of shock was defined as maintaining a mean arterial pressure ≥65 mmHg without vasopressor support for ≥12 hours.
The primary outcome was recurrence of septic shock, defined as vasopressor reinitiation within 72 hours or escalation in vasopressor or hydrocortisone therapy. Secondary outcomes included duration of vasopressor therapy, ICU length of stay, hospital length of stay, and incidence of hyperglycemia (≥180 mg/dL). Continuous variables were analyzed using Wilcoxon rank-sum tests, and categorical variables using chi-square or Fisher’s exact tests, as appropriate.
Results:
A total of 43 patients were included (no taper n=30; taper n=13). Baseline characteristics were similar between groups, with no statistically significant differences in age, sex, vasopressor requirements, or severity markers.
Recurrence of septic shock occurred in 30% of the no-taper group and 38% of the taper group (p=0.7), demonstrating no statistically significant difference between strategies. Median duration of vasopressor therapy was similar (136 hours vs 123 hours; p=0.6).
There were no significant differences in secondary outcomes, including ICU length of stay (8 vs 7 days; p>0.9), hospital length of stay (18 vs 16 days; p=0.8), or incidence of hyperglycemia (70% vs 69%; p>0.9).
Conclusions:
In this retrospective cohort study, tapering of hydrocortisone did not reduce the recurrence of septic shock compared to abrupt discontinuation. No differences were observed in vasopressor duration, length of stay, or hyperglycemia. These findings suggest that routine tapering of hydrocortisone may not provide clinical benefit in this population. Prospective studies are warranted to confirm these findings and inform guideline recommendations.