Wu Jheng-Yen, Liu Mei-Yuan, Liu Ting-Hui, Huang Po-Yu, Restinia Mita, Hsu Wan-Hsuan, Tsai Ya-Wen, Chuang Min-Hsiang, Hung Kuo-Chuan, Lai Chih-Cheng
Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan.
Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Infection. 2025 Apr;53(2):553-560. doi: 10.1007/s15010-024-02381-z. Epub 2024 Aug 27.
This study assessed the effect of hydrocortisone-fludrocortisone combination therapy on the mortality of patients with septic shock.
A 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.
Seven 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.
This study emphasizes the potential survival benefits of hydrocortisone-fludrocortisone combination therapy for patients with septic shock and its additional advantages, including reduced vasopressor use.
本研究评估了氢化可的松 - 氟氢可的松联合治疗对感染性休克患者死亡率的影响。
使用Medline、Embase、Cochrane图书馆、ClinicalTrials.gov和其他数据库进行文献检索，检索截至2023年10月1日发表的文章。仅纳入评估氢化可的松 - 氟氢可的松治疗感染性休克的临床疗效和安全性的临床研究。主要结局是院内死亡率。
纳入了7项研究，共90756例患者。研究组的院内死亡率较低（40.8%对42.8%；比值比，0.86；95%置信区间，0.80 - 0.92）。与对照组相比，研究组的重症监护病房（ICU）死亡率也较低（比值比，0.77；95%置信区间，0.63 - 0.95），28天死亡率（比值比，0.85；95%置信区间，0.72 - 1.00），90天死亡率（比值比，0.85；95%置信区间，0.71 - 1.01），180天死亡率（比值比，0.82；95%置信区间，0.68 - 0.90）和1年死亡率（比值比，0.70；95%置信区间，0.42 - 1.16）。亚组分析显示了类似的趋势，在随机临床试验、多中心研究和ICU患者的汇总分析中尤为突出，研究药物方案为每6小时给予50毫克氢化可的松联合每日50微克氟氢可的松，对照组接受安慰剂或标准治疗。氢化可的松 - 氟氢可的松还增加了无血管活性药物天数并缩短了血管活性药物使用时间，且未增加不良事件风险。
本研究强调了氢化可的松 - 氟氢可的松联合治疗对感染性休克患者的潜在生存益处及其额外优势，包括减少血管活性药物的使用。
