Ann Pharmacother

Corticosteroids favored over vasopressin for improved septic shock survival

January 15, 2026

Adding hydrocortisone rather than vasopressin as the initial adjunct to norepinephrine in septic shock was associated with significantly lower in-hospital mortality (37.3% vs. 53.3%; adjusted hazard ratio [HR], 1.80; 95% confidence interval [CI], 1.19-2.74; P=0.006) in a multicenter retrospective study of 628 ICU patients. Hydrocortisone also demonstrated shorter hospital length of stay and reduced need for renal replacement therapy compared with vasopressin. Notably, delayed initiation of either adjunctive agent increased mortality risk (HR, 1.08; 95% CI, 1.04-1.11; P<0.001), emphasizing the importance of early escalation when norepinephrine requirements rise.

Clinical takeaway: In septic shock with escalating norepinephrine requirements, consider early hydrocortisone as the first adjunctive agent to improve survival and reduce complications.

Source:

Wang HF, et al. (2026, January 7). Ann Pharmacother. Comparing Vasopressin and Hydrocortisone as Adjunctive Measures in Septic Shock. https://pubmed.ncbi.nlm.nih.gov/41499208/