30 May 2023 • In a study published in the New England Journal of Medicine: Evidence, an international team of researchers studied the role of hydrocortisone in the management of adult patients with septic shock. They found that while the effect of hydrocortisone was modest in terms of overall survival, it was associated with a decrease in the need for vasopressor drugs and improvement in survival when used in combination with other corticosteroids.

The research team performed a meta-analysis of the effect of hydrocortisone on patients with septic shock by pooling individual data from studies conducted between 1998 and 2019 including including 7882 adult patients with sepsis or septic shock who received intravenous hydrocortisone at a maximum daily dose of 400 mg for at least 72 hours, or a placebo.

The researchers found that hydrocortisone was not associated with a significant reduction in mortality for patients with septic shock compared to placebo. Hydrocortisone was, however, associated with a significant increase, on average of 1.24 days, in the number of days without the need for vasopressor drugs.

The study also suggests that the association of fludrocortisone, a corticosteroid with a strong action on the regulation of water and sodium, with hydrocortisone might reduce mortality.

“For the first time, the effects of hydrocortisone for the treatment of patients with septic shock could be studied by analysing individual data from the main randomised trials published to date,” said Pirracchio. “This study shows that if the effect of hydrocortisone on the mortality of septic shock is modest, this treatment makes it possible to spare the exposure of patients to vasopressor drugs and to prevent their complications. The combination of fludrocortisone with hydrocortisone seems to provide a greater benefit in terms of survival.” says first author, Dr. Romain Pirracchio, MD, MPH, PhD.

Source: NEJM Evidence | Read full story