Pneumonia · Corticosteroids in severe pneumonia
Hydrocortisone in Severe Community-Acquired Pneumonia
| Design | Randomised, double-blind, placebo-controlled trial, stopped early |
|---|---|
| Treatment | Intravenous hydrocortisone |
| Control | Placebo |
| Population | 795 patients with severe community-acquired pneumonia treated in intensive care |
| Follow-up | 28 days |
| Primary endpoint | Death from any cause at day 28 |
| Result | Death by day 28 occurred in 25 of 400 (6.2%, 95% CI 3.9 to 8.6) with hydrocortisone versus 47 of 395 (11.9%, 8.7 to 15.1) with placebo — absolute difference -5.6 percentage points (95% CI -9.6 to -1.7, p=0.006). The trial was stopped after the second planned interim analysis. |
| Secondary endpoints | Intubation among those not initially ventilated, vasopressor initiation, ICU length of stay |
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.
The trial authors, in the published abstract
After decades of equivocal steroid trials in pneumonia, a clear mortality benefit — but confined to severe disease requiring intensive care, which is the boundary that matters when generalising it to the ward. Note the contrast with ARDS, where the steroid question remains less settled (DEXA-ARDS).
Dequin PF, Meziani F, Quenot JP, et al. Hydrocortisone in Severe Community-Acquired Pneumonia. N Engl J Med 2023 May 25;388(21):1931-1941.