Combo Steroid Treatment May Work Best When Sepsis Strikes

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Giving patients who have septic shock a combo of two steroids could potentially be a lifesaver, according to a new study.

Researchers found that patients receiving a combination of hydrocortisone and fludrocortisone had lower death rates and discharge to hospice compared to those who received hydrocortisone alone.

“Our results provide robust evidence that one steroid regimen is superior to the other regimen and, in absence of further clinical trials, directly inform the choice of steroids in patients with septic shock,” said study co-author Dr. Nicholas Bosch, an assistant professor at Boston University’s Chobanian & Avedisian School of Medicine.

For the study, published March 27 in JAMA Internal Medicine, researchers compared treatment options using a multicenter database that included about 25% of U.S. hospitalizations. The study was designed to mimic a randomized clinical trial.

The team compared the outcome of death or discharge to hospice between patients who received the regimen of hydrocortisone and fludrocortisone to those who received hydrocortisone alone.

On average, patients who received the combined regimen died or were discharged to hospice about 4% less of the time than patients who received hydrocortisone alone.

More than a third of the estimated 1.7 million U.S. hospitalizations involving sepsis — an extreme response to infection — each year end in death.

These findings may change clinical practice, the authors said.

“It is possible that guideline recommendations, which currently suggest to start hydrocortisone alone, will change as a result of this study,” Bosch said in a university news release. He is also a pulmonologist at Boston Medical Center.

The researchers say the study may have impact in other ways, as well, such as its use of a technique called target trial emulation 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.

More information

The U.S. Centers for Disease Control and Prevention has more on sepsis.

SOURCE: Boston University Chobanian & Avedisian School of Medicine, news release, March 27, 2023

Source: HealthDay

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