EVALUATION OF THE ROLE OF HYDROCORTISONE EITHER ALONE OR COMBINED WITH FLUDROCORTISONES IN THE OUTCOME OF SEPTIC SHOCK IN ADULTS

Septic shock is distinguished by a dysregulated host response to infection. It may result in life-threatening circulatory, cellular, and metabolic abnormalities. The short-term mortality is approximately 45 to 50%, and survivors of sepsis may have subsequent long-term cognitive decline. At a distance from early hemodynamic and respiratory resuscitation and appropriate anti-infective treatments, there is no approved adjunct therapy for sepsis. In this study we evaluated the effect of hydrocortisone-plus-fludrocortisone therapy, drotrecogin alfa (activated), the combination of the three drugs and their respective placebos. The primary outcome was 90-day all-cause mortality. Secondary outcomes included mortality at intensive care unit (ICU) discharge and hospital discharge and at day 28 and day 180 and the number of days alive and free of vasopressors, mechanical ventilation, or organ failure. At day 90, death had occurred in 264 of 620 patients (42.5%; 95% confidence interval [CI], 39.0 to 45.0) in the hydrocortisone-plus-fludrocortisone group and in 308 of 610 patients (50.4%; 95% CI, 46.1 to 55.1) in the placebo group (P = 0.03) (Table 2 and Fig. 1). The relative risk of death was 0.99 (95% CI, 0.78 to 0.99) in favor of hydrocortisone-plus-fludrocortisone therapy. In this trial involving patients with septic shock. Seven -day treatment with a 50-mg intravenous bolus of hydrocortisone every 6 hours and a everyday dose of 50 ?g of oral fludrocortisone ended in decrease mortality at day 90 and at ICU and clinic discharge than placebo among adults with septic shock