Effect of hydrocortisone on mortality in patients with severe community-acquired pneumonia : The REMAP-CAP Corticosteroid Domain Randomized Clinical Trial
An erratum to this article was published (Intensive Care Med, Jul 2025 ↗)
- stopped for futility
Authors' conclusion
Among patients with severe CAP, treatment with a 7-day course of hydrocortisone, compared with no hydrocortisone, appears unlikely to yield a large reduction in mortality. Smaller benefits and possible harm are not excluded.
Study context
- Population
- Adults admitted to the intensive care unit (ICU) with severe community-acquired pneumoniavital status missing for 15
- Participants
- 658 adults
- Comparison
- 7-day IV hydrocortisone vs no corticosteroid
- Hydrocortisonen = 536
- Controln = 122reference
- Primary endpoint
- All-cause mortality
- Follow-up
- 90 days
Methodological detailsinternational, adaptive platform trial, Bayesian hierarchical model
- International
- Adaptive platform trial
- Bayesian hierarchical model
Primary result
As reported in the abstract
90-day all-cause mortality · Day 90
- Adjusted OR range across influenza and shock strata
- 1.52 to 1.63 (all 95% CrI crossing 1)
- Probability of > 20% relative reduction of day 90 mortality across influenza and shock strata
- 7.1 to 3.3%
Secondary outcomes
Duration of shock (exploratory) · exploratory analysis
P = 0.05
Sensitivity and prespecified secondary outcomes
- Results consistent with primary
Original publication
Effect of hydrocortisone on mortality in patients with severe community-acquired pneumonia : The REMAP-CAP Corticosteroid Domain Randomized Clinical Trial. Intensive Care Med. Published 22 April 2025. doi:10.
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