Hydrocortisone and fludrocortisone combo improves hospital discharge and survival in patients with Sepsis

They found that the regimen of hydrocortisone and fludrocortisone together was superior to hydrocortisone alone; on average, patients who received hydrocortisone and fludrocortisone died or were discharged to hospice approximately four percent less of the time compared to patients who received hydrocortisone alone.

According to the researchers, these findings may change clinical practice. “It is possible that guideline recommendations, which currently suggest to start hydrocortisone alone, will change as a result of this study,” said Bosch, who also is a pulmonologist at Boston Medical Center.

The researchers believe this study has additional implications due to its use of target trial emulation, a modern approach to comparative effectiveness studies using observational data ("big" electronic health record data) that is designed to mimic a prospective randomized controlled trial. “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,” Bosch said.

Reference:

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. Published online March 27, 2023. doi:10.1001/jamainternmed.2023.0258.