Do We Need to Administer Fludrocortisone in Addition to Hydrocortisone in Adult Patients With Septic Shock? An Updated Systematic Review With Bayesian Network Meta-Analysis of Randomized Controlled Trials and an Observational Study With Target Trial Emulation.

"Dr. Huang received support for article research from the National Cheng Kung University Hospital, Tainan, Taiwan (NCKUH-11209002). The remaining authors have disclosed that they do not have any potential conflicts of interest."

"Dr. Huang received support for article research from the National Cheng Kung University Hospital, Tainan, Taiwan (NCKUH-11209002). The remaining authors have disclosed that they do not have any potential conflicts of interest."

"For assessing the efficacy and safety of hydrocortisone plus fludrocortisone, hydrocortisone alone, and placebo in adult patients with septic shock, we conducted a systematic review with network meta-analysis (NMA) by following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guideline (). Our research protocols were registered on INPLASY (registration number: INPLASY202360053, https://inplasy.com/inplasy-2023-6-0053/) and were updated on July 30, 2023, and August 31, 2023. By drawing from a Cochrane review (), investigators P.C.L. and Y.T.H. searched databases, such as PubMed, Embase, Cochrane Library, and ClinicalTrials.gov, along with other relevant websites until August 31, 2023. We used free text and medical subject headings with keywords, such as “septic shock,” “hydrocortisone,” and “fludrocortisone,” without language restriction. Only parallel RCTs and observational studies with target trial emulation (TTE) were included. Discrepancies were addressed through group consensus."