Evidence map›Paper›PMID 39192056›Full record

SynthesisInfection2025

Effect of hydrocortisone-fludrocortisone combination on mortality in septic shock: a systematic review and meta-analysis.

Jheng-Yen Wu, Mei-Yuan Liu, Ting-Hui Liu, Po-Yu Huang, Mita Restinia, Wan-Hsuan Hsu, Ya-Wen Tsai, Min-Hsiang Chuang, Kuo-Chuan Hung, Chih-Cheng Lai

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Infection, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Jheng-Yen Wu *Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan.
Mei-Yuan Liu *Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan.
Ting-Hui LiuDepartment of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan.
Po-Yu HuangDepartment of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
Mita RestiniaDepartment of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Wan-Hsuan HsuDepartment of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
Ya-Wen TsaiCenter of Integrative Medicine, Chi Mei Medical Center, Tainan, Taiwan.
Min-Hsiang ChuangDivision of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
Kuo-Chuan HungDepartment of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.
Chih-Cheng LaiSchool of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan. dtmed141@gmail.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThis study assessed the effect of hydrocortisone-fludrocortisone combination therapy on the mortality of patients with septic shock.

methodsA literature search was conducted using Medline, Embase, the Cochrane Library, ClinicalTrials.gov, and other databases for articles published until October 1, 2023. Only clinical studies that assessed the clinical efficacy and safety of hydrocortisone-fludrocortisone therapy for the treatment of septic shock were included. The primary outcome was the in-hospital mortality rate.

resultsSeven studies with a total of 90, 756 patients were included. The study group exhibited lower in-hospital mortality rates (40.8% vs. 42.8%; OR, 0.86; 95% CI, 0.80-0.92). Compared to the control group, the study group also had lower intensive care unit (ICU) mortality (OR, 0.77; 95% CI, 0.63-0.95), 28-day mortality (OR, 0.85; 95% CI, 0.72-1.00), 90-day mortality (OR, 0.85; 95% CI, 0.71-1.01), 180-day mortality (OR, 0.82; 95% CI, 0.68-0.90), and one-year mortality (OR, 0.70; 95% CI, 0.42-1.16). Subgroup analyses showed a similar trend, particularly prominent in the pooled analysis of randomized clinical trials, multicenter studies, and ICU patients, the study drug regimen involved hydrocortisone at a dose of 50 mg every 6 h in combination with fludrocortisone at 50 µg daily, with the control group receiving either placebo or standard care. Hydrocortisone-fludrocortisone also increased vasopressor-free days and reduced vasopressor duration, without elevating the risk of adverse events.

conclusionsThis study emphasizes the potential survival benefits of hydrocortisone-fludrocortisone combination therapy for patients with septic shock and its additional advantages, including reduced vasopressor use.

Indexed as

Anti-Inflammatory AgentsFludrocortisoneHydrocortisoneShock, SepticDrug Therapy, CombinationHospital MortalityHumansIntensive Care UnitsTreatment OutcomeAnti-Inflammatory AgentsFludrocortisoneHydrocortisoneFludrocortisoneHydrocortisoneMortalitySepsisSeptic shock

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.