Sepsis & septic shock · Steroids in septic shock
Hydrocortisone plus Fludrocortisone for Adults with Septic Shock
| Design | Multicentre, double-blind randomised controlled trial |
|---|---|
| Treatment | Hydrocortisone plus oral fludrocortisone |
| Control | Placebo |
| Population | 1241 patients with septic shock |
| Follow-up | 90 days |
| Primary endpoint | All-cause mortality at 90 days |
| Result | 90-day mortality was 43.0% (264 of 614) with hydrocortisone plus fludrocortisone versus 49.1% (308 of 627) with placebo (p=0.03). |
| Secondary endpoints | Vasopressor-free days, organ failure-free days, ICU and hospital mortality |
In this trial involving patients with septic shock, 90-day all-cause mortality was lower among those who received hydrocortisone plus fludrocortisone than among those who received placebo.
The trial authors, in the published abstract
The positive counterpart to ADRENAL, published simultaneously. It enrolled sicker patients, added fludrocortisone and used boluses rather than an infusion — any of which might explain the difference, and none of which has been tested head to head. A rare case where two large trials of the same question genuinely disagree.
Annane D, Renault A, Brun-Buisson C, et al. Hydrocortisone plus Fludrocortisone for Adults with Septic Shock. N Engl J Med 2018 Mar 1;378(9):809-818.