Hydrocortisone Plus Fludrocortisone Superior for Septic Shock

THURSDAY, April 13, 2023 (HealthDay News) -- Among adult patients with septic shock who begin hydrocortisone treatment, the addition of fludrocortisone is superior to hydrocortisone alone, according to a study published online March 27 in JAMA Internal Medicine.

Nicholas A. Bosch, M.D., from the Boston University Chobanian & Avedisian School of Medicine, and colleagues compared the effectiveness of fludrocortisone added to hydrocortisone versus hydrocortisone alone among patients with septic shock. The analysis for the retrospective cohort study included 88,275 adult patients hospitalized with septic shock who received norepinephrine and began hydrocortisone treatment during 2016 to 2020.

The researchers found that the primary composite outcome of death in hospital or discharge to hospice occurred among 47.2 percent of patients treated with hydrocortisone-fludrocortisone versus 50.8 percent treated with hydrocortisone alone (adjusted absolute risk difference, −3.7 percent).

"Our results provide robust evidence that one steroid regimen is superior to the other regimen and, in absence of further clinical trials, directly inform the choice of steroids in patients with septic shock. It is possible that guideline recommendations, which currently suggest to start hydrocortisone alone, will change as a result of this study," Bosch said in a statement. "These target trial emulations are likely to be seen with increasing frequency going forward as 'big data' becomes more and more available and have the potential to answer complex clinical questions in situations where a randomized clinical trial may not be feasible."

Two authors disclosed financial ties to Gilead Sciences.

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