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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.


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