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A new study finds that while hydrocortisone on its own may not prevent death from sepsis, it can improve survival when combined with other steroids while eliminating the need for vasopressor drugs.
Vasopressor medications help raise blood pressure when it's so low that you can't get enough blood to your organs. Doctor often deliver these drugs via an IV.
“For the first time, the effects of hydrocortisone for the treatment of patients with septic shock could be studied by analyzing individual data from the main randomized trials published to date,” said researcher Dr. Romain Pirracchio, a professor of anesthesia at University of California, San Francisco (UCSF).
“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," he added in a UCSF news release. "The combination of fludrocortisone with hydrocortisone seems to provide a greater benefit in terms of survival.”
Sepsis is the body's extreme response to infection, according to the U.S. Centers for Disease Control and Prevention.
It affects about 55 million people worldwide and causes 11 million deaths each year. Treatment can include recognizing it quickly, controlling the source of the infection, antibiotics, fluids, vasopressors and other therapies.
Corticosteroids have been one of these therapies for septic shock for more than 50 years, but uncertainty has continued about the impact of using corticosteroids on patient deaths.
So, an international team of researchers studied the role of hydrocortisone in the management of adult patients with septic shock.
They did this using a meta-analysis of the effect of hydrocortisone on patients who had septic shock by pooling individual data from studies conducted between 1998 and 2019. These included adult patients with sepsis or septic shock who received intravenous hydrocortisone at a maximum daily dose of 400 milligrams (mg) for at least 72 hours, or a placebo.
In all, 17 studies had individual patient data, while seven had 90-day death data.
The researchers were looking for 90-day all-cause deaths, as well as deaths in the intensive care unit and discharge from the hospital at 28 and 180 days. They were also looking for the number of days without the need for vasopressor drugs to maintain cardiovascular function, without a ventilator, and the number of days without vital organ failure.
While hydrocortisone did not have a significant impact on reducing deaths in patients with septic shock compared to a placebo, it was associated with a significant increase, on average 1.24 days, in the number of days without the need for vasopressor drugs.
Using fludrocortisone, a corticosteroid with a strong action on the regulation of water and sodium, with hydrocortisone might reduce deaths, according to the researchers.
The findings were published May 22 in NEJM: Evidence.
The U.S. Centers for Disease Control and Prevention has more on sepsis.
SOURCE: University of California, San Francisco, news release, May 22, 2023
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