"Hydrocortisone in Severe Community-Acquired Pneumonia".
Links to original sources: Wiki Journal Post Full Journal Article
The New England Journal of Medicine. 2023.
Does the administration of hydrocortisone reduce 28-day mortality in patients with severe community-acquired pneumonia being treated in the ICU?
In patients with severe community-acquired pneumonia being treated in the ICU, the administration of hydrocortisone resulted in lower 28-day mortality compared with placebo.
Community-acquired pneumonia can lead to severe systemic inflammation, causing significant morbidity and mortality. Previous trials suggested that glucocorticoids could reduce mortality among patients with severe community-acquired pneumonia, but results were often inconclusive. The Community-Acquired Pneumonia: Evaluation of Corticosteroids (CAPE COD) trial demonstrated that early hydrocortisone therapy decreased 28-day mortality in patients admitted to the ICU for severe community-acquired pneumonia, with no significant increase in hospital-acquired infections or gastrointestinal bleeding.
The results of this study could influence future guidelines on the therapy for severe community-acquired pneumonia in the ICU.
Double-blind, randomized, controlled superiority trial.
795 adults admitted to the ICU for severe community-acquired pneumonia.
Inclusion Criteria - Adults ≥18 years - Severe community-acquired pneumonia requiring ICU admission - Presence of specific severity criteria for pneumonia
Exclusion Criteria - Do-not-intubate order - Pneumonia caused by influenza - Septic shock at baseline - Other specified criteria
Baseline Characteristics - Gender distributions, pathogen profiles, and other baseline health characteristics were detailed.
Patients randomized to hydrocortisone group received: - 200mg intravenous hydrocortisone daily for 4 or 7 days based on clinical improvement, followed by tapering over a total of 8 or 14 days - Standard therapy for severe community-acquired pneumonia (antibiotics and supportive care)
Patients in placebo group received: - Intravenous saline with an identical regimen to the hydrocortisone group
Primary Outcome: - 28-day mortality rate (6.2% in the hydrocortisone group versus 11.9% in the placebo group, P=0.006)
- 90-day mortality rate - Length of ICU stay - Ventilator-free days and vasopressor-free days - Incidence of endotracheal intubation in patients not ventilated at baseline - Initiation of vasopressor therapy by day 28 - Changes in the Pao2:Fio2 ratio and SOFA score by day 7 - Quality of life assessed by SF-36 scores
- Lower than expected mortality in the control group suggests lower severity of illness than anticipated. - No standardized microbiologic evaluation, with many patients with no documented pathogen. - Exclusion of patients with septic shock. - Did not evaluate the reversibility of glucocorticoid-induced hyperglycemia.
Funded by the French Ministry of Health.
Complete trial data and supplementary material are available at NEJM.org.