Hydrocortisone in Severe Community-Acquired Pneumonia
Primary result · DeathResult — go to the resultAbsolute difference −5.6 percentage points 95% CI −9.6 to −1.7- stopped after second planned interim analysis
Authors' conclusion
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.
Study context
- Population
- Adults admitted to the intensive care unit (ICU) for severe community-acquired pneumonia795 analysed
- Participants
- 800 adults
- Comparison
- IV hydrocortisone vs placebo, plus standard therapy
- Hydrocortisonen = 400
- Placebon = 395reference
- Primary endpoint
- Death
- Follow-up
- 28 days
Methodological detailsphase 3, multicentre, double-blind
- Phase 3
- Multicentre
- Double-blind
Primary result
As reported in the abstract
day 28
Absolute difference
−5.6 percentage points
95% CI −9.6 to −1.7
P = 0.006
Events by treatment group
Hydrocortisone vs Placebo
absolute difference −5.6 percentage points (95% CI −9.6 to −1.7); P = 0.006
Further findings
| Outcome | Hydrocortisone | Placebo | HR (95% CI) | |
|---|---|---|---|---|
| Endotracheal intubation (patients not on mechanical ventilation at baseline) | 18.0% | 29.5% | 0.59 (0.40–0.86) | |
| Vasopressor initiation (patients not on vasopressors at baseline) · day 28 | 15.3% | 25.0% | 0.59 (0.43–0.82) | |
| 0.512Hazard ratio (log scale) |
- Endotracheal intubation (patients not on mechanical ventilation at baseline): 40 of 222 vs 65 of 220
- Vasopressor initiation (patients not on vasopressors at baseline): 55 of 359 vs 86 of 344
Safety
- Hospital-acquired infections and gastrointestinal bleeding similar in the two groups
- Higher daily insulin doses in the hydrocortisone group during the first week
Original publication
Hydrocortisone in Severe Community-Acquired Pneumonia. N Engl J Med. Published 21 March 2023. doi:10.
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