RCT | Hydrocortisone reduces mortality in severe community-acquired pneumonia

Summary: Practice-changing! In a phase 3, multicenter, double-blind, randomized controlled trial involving 800 patients with severe community-acquired pneumonia admitted to the ICU, hydrocortisone treatment was found to reduce the risk of death by day 28 compared to a placebo group. The hydrocortisone group had a 6.2% death rate, while the placebo group had an 11.9% death rate.

Hydrocortisone also led to fewer endotracheal intubations among patients not on mechanical ventilation at baseline and reduced the need for vasopressor therapy in patients not receiving it at baseline. There was no significant difference in hospital-acquired infections or gastrointestinal bleeding between the two groups, but patients in the hydrocortisone group required higher daily doses of insulin during the first week of treatment.

Article: Hydrocortisone in Severe Community-Acquired Pneumonia – New England Journal of Medicine (link to abstract – $ for full-text)

Commentary: Steroid drug reduces death rate in severe pneumonia, study shows – STAT

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In this randomized trial, hydrocortisone treatment decreased mortality among patients with severe community-acquire pneumonia in the ICU. https://t.co/DZadFMcA5o#ISICEM23 pic.twitter.com/yhkVCjBMWX

— NEJM (@NEJM) March 21, 2023