| Infection can cause multiple symptoms when combined they cause systemic inflammatory response syndrome (SIRS), i.e.,
sepsis. Sepsis is a condition that is manifested clinically by physiological, biological, and biochemical abnormalities, and
its main cause is the uncontrolled inflammatory response of infection. Septic shock is distinguished by a dysregulated host
response to infection. It may resulting 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,
drotrecoginalfa (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) . The relative risk of death was 0.99 (95% CI, 0.78 to 0.99) in favor of hydrocortisone-plusfludrocortisone 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. The corticosteroids in septic shock
have significant positive impacts on some aspects in treatment of septic shock but it does not affect the mortality rate of the
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