Infectious Disease & Sepsis

Another new retrospective cohort study that compares the effectiveness of adding fludrocortisone to hydrocortisone vs hydrocortisone alone among patients with septic shock using target trial emulation.

The study found that among 88,275 patients with septic shock receiving norepinephrine who initiated hydrocortisone treatment, the addition of fludrocortisone to hydrocortisone was associated with a 3.7% lower adjusted absolute risk difference in the primary composite outcome of mortality or discharge to hospice compared with initiation of hydrocortisone alone.

The study concludes that among patients with septic shock receiving norepinephrine who initiated hydrocortisone treatment, the addition of fludrocortisone was associated with lower rates of the composite of death or discharge to hospice compared with hydrocortisone alone.

Bosch NA, Teja B, Law AC, Pang B, Jafarzadeh SR, Walkey AJ. Comparative Effectiveness of Fludrocortisone and Hydrocortisone vs Hydrocortisone Alone Among Patients With Septic Shock. JAMA Intern Med. 2023;183(5):451–459. doi:10.1001/jamainternmed.2023.0258

Comparative Effectiveness of Fludrocortisone and Hydrocortisone vs Hydrocortisone Alone Among Patients With Septic Shock

The study aimed to compare the effectiveness of adding fludrocortisone to hydrocortisone vs hydrocortisone alone among patients with septic shock. The study was a retrospective cohort study using the enhanced claims-based Premier Healthcare Database from 2016 to 2020. The primary outcome was a composite of hospital death or discharge to hospice. The results showed that the addition of fludrocortisone on the same calendar day that hydrocortisone treatment was initiated was superior to hydrocortisone alone among adult patients with septic shock who began hydrocortisone treatment. The study concluded that the addition of fludrocortisone to hydrocortisone may be a more effective treatment option for septic shock patients.

Comparative Effectiveness of Fludrocortisone and Hydrocortisone vs Hydrocortisone Alone Among Patients With Septic Shock | Critical Care Medicine | JAMA Internal Medicine | JAMA Network