The Effect of Hydrocortisone Versus Hydrocortisone Plus Fludrocortisone on Shock-Free Days
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Sepsis, Pharmacology, 2022
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INTRODUCTION: The aim of this study is to assess the impact of the addition of fludrocortisone to hydrocortisone on shock-free days in patients with septic shock. METHODS: A single-center, retrospective propensity score weighted cohort study was conducted to compare hydrocortisone versus hydrocortisone plus fludrocortisone in patients with septic shock. Adult patients aged 18-89 years admitted to a tertiary academic medical center medical intensive care unit (MICU) from 2015-2020 and diagnosed with septic shock were included if they received ≥200 mg/day hydrocortisone for at least 24 hours ± fludrocortisone initiated within 72 hours of vasopressors. Propensity score matching utilizing inverse probability weighting and trimming was performed. The primary outcome was the number of shock-free days by day 14. Secondary outcomes included duration of shock, change in Sequential Organ Failure Assessment (SOFA) score, maximum daily vasopressor dose in norepinephrine equivalents on days 1-7, hospital and ICU length of stay, and in-hospital mortality. RESULTS: A total of 228 patients met inclusion criteria. 212 patients were retained after propensity score matching with 111 in the hydrocortisone group and 101 in the hydrocortisone plus fludrocortisone group. Three hundred and eighty-three patients were excluded with the most common reasons being receipt of glucocorticoids for any indication other than septic shock during study period (n=139) and mixed shock diagnosis (n=74). After score weighting, there were no significant differences in baseline characteristics between groups. There was no statistical difference between treatment groups in regard to 14-day shock-free days (6.3 vs 6.1 days; p=0.781) or in-hospital mortality (46.7 vs 52.2%, p=0.477). Furthermore, there were no significant differences observed regarding the secondary outcomes of ICU and hospital length of stay, duration of shock, or change in SOFA score. With respect to maximum daily vasopressor doses, days 1-6 were not significantly different, however, day 7 did have a significant difference between the two groups (0.00 vs 0.1 NEeq p=0.03). CONCLUSIONS: The addition of fludrocortisone to hydrocortisone in septic shock did not increase the number of shock-free days. Further studies are needed to assess the clinical utility of these findings.
Meta Tag
Content Type Presentation
Knowledge Area Sepsis
Knowledge Area Pharmacology
Knowledge Level Intermediate
Knowledge Level Advanced
Learning Pathway Sepsis Resources
Membership Level Select
Tag Shock
Tag Pharmacology
Tag Corticosteroid
Year 2022
septic shock
retrospective study
Sepsis Resources


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