NEJM
March 21, 2023
Hydrocortisone in Severe Community-Acquired Pneumonia
Mazen Kherallah
Summarized by:
What was the research question?
Population: Adults admitted to the ICU for severe community-acquired pneumonia
Intervention: Intravenous hydrocortisone
Comparison: Placebo
Outcome: Death at 28 days
How did they do it?
Design: Phase 3, multicenter, double-blind, randomized, controlled trial
Settings: 31 intensive care units in France
Patients: Adults with severe community-acquired pneumonia
Outcome measures: Death at 28 days, endotracheal intubation, vasopressor initiation, hospital-acquired infections, gastrointestinal bleeding, and insulin doses
What did they find?
Death at 28 days: 6.2% in the hydrocortisone group, 11.9% in the placebo group (absolute difference: -5.6 percentage points, 95% CI -9.6 to -1.7, P=0.006)
Endotracheal intubation: 18.0% in the hydrocortisone group, 29.5% in the placebo group (hazard ratio: 0.59, 95% CI 0.40 to 0.86)
Vasopressor initiation: 15.3% in the hydrocortisone group, 25.0% in the placebo group (hazard ratio: 0.59, 95% CI 0.43 to 0.82)
Hospital-acquired infections and gastrointestinal bleeding: Similar in both groups
Insulin doses: Higher daily doses in the hydrocortisone group during the first week of treatment
What does it mean?
Among patients with severe community-acquired pneumonia being treated in the ICU, those who received hydrocortisone had a lower risk of death by day 28 than those who received placebo.
Intravenous hydrocortisone may be a beneficial adjunct in the treatment of severe community-acquired pneumonia in ICU patients, as it is associated with a lower risk of death and other complications.