Category: Critical Care
Keywords: shock, cardiogenic shock, corticosteroids (PubMed Search)
Posted: 6/16/2026 by Mark Sutherland, MD
(Updated: 6/17/2026)
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There were a handful of big name critical care studies published the last few weeks (LOGICAL, ARISE FLUIDS, SODa-BIC to name a few) but many of you probably already saw those so we're gonna stick with something a little more off the beaten path.
A retrospective observation trial was published recently by Gastanadui et al in Journal of Intensive Care looking at the mortality impact of corticosteroids in cardiogenic shock. They looked at 167,721 patients from the Vizient database admitted with cardiogenic shock (excluded patients with other indications for steroids). The unadjusted mortality was a whopping 48.8% in the steroid group and 29.6% in the non-steroid group. They did Inverse Probability Treatment Weighting (IPTW), which attempts (imperfectly, but best as you can retrospectively) to control for treatment selection bias, and still found a roughly 3% mortality increase in the steroid group.
Bottom Line: Corticosteroids were already controversial (at best) in cardiogenic shock, but this further adds to the reasons to avoid them in this condition. Of note, this trial excluded patients with classic hard-indications (e.g. adrenal insufficiency, COPD exacerbation, etc) and steroids should still be given to those groups, but in my opinion if you feel cardiogenic is the primary driver of the patient's shock and they do not have another indication, I would consider avoiding steroids solely for the shock.
Gastanadui MG, Murphy HR, Shahu A, Safiriyu I, Heck C, Hysolli M, Callegari S, Garimella S, Ali T, Jentzer JC, Gage A, Jacobs M, Katz JN, Miller PE. Early Corticosteroid use and Clinical Outcomes in Patients with Mixed and Cardiogenic Shock. J Intensive Care Med. 2026 Jun 1:8850666261437767. doi: 10.1177/08850666261437767. Epub ahead of print. PMID: 42223374.
