Sepsis causes 11 million deaths annually so preventing that requires prompt recognition, source control, antibiotics, fluids and vasopressors.

Sometimes adjunctive therapies such as orticosteroids help but the science is inconclusive. A recent study was designed to evaluate the role of corticosteroids in the management of patients with septic shock and the contradictory effects on mortality as recorded in past research and treatment.

The results were that hydrocortisone was negligible in terms of overall survival but was associated with a decrease in the need for vasopressor drugs, an average of 1.24 days, and improvement in survival when used in combination with other corticosteroids. The hydrocortisone correlation may have been due to fludrocortisone, a corticosteroid with a strong action on the regulation of water and sodium.

“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 UC San Francisco Professor Romain Pirracchio, MD. “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. The combination of fludrocortisone with hydrocortisone seems to provide a greater benefit in terms of survival.”