Hydrocortisone Lowers Risk of Death in Severe Community-Acquired Pneumonia

Glucocorticoids are steroid hormones, commonly used to treat autoimmune diseases, inflammation, and cancer. A new study, published in the New England Journal of Medicine, examined whether the anti-inflammatory and immunomodulatory effects of glucocorticoids could decrease mortality in patients with severe community-acquired pneumonia (CAP).

This study specifically utilized the glucocorticoid medicine hydrocortisone, which calms the body’s immune response to downregulate pain, itching, and swelling.

The phase 3, multicenter, randomized, double-blind, controlled trial recruited adults who had been admitted to the intensive care unit (ICU) with severe CAP. The patients were randomly assigned to either placebo or 200 mg intravenous hydrocortisone, administered daily for either 4 or 8 days (determined by clinical improvement), with follow-up tapering for either 8 or 14 days.

All patients received standard care, including antibiotics and supportive therapy, in addition to either hydrocortisone or placebo. The primary outcome of interest was death at 28 days.

Data from 795 adult patients were analyzed. By day 28, death occurred in 25 of 400 patients in the hydrocortisone group (6.2%), and 47 of 395 patients in the placebo group (11.9%).

In patients who were not undergoing mechanical ventilation at baseline, endotracheal intubation was performed in 40 of 222 (18.0%) of the hydrocortisone recipients and 65 of 220 (29.5%) placebo recipients. Among patients who were not receiving vasopressors at baseline, the therapy was initiated by day 28 in 55 of 359 (15.3%) of the hydrocortisone group and in 86 of 344 (25.0%) of the placebo group.

Incidences of hospital-acquired infections and gastrointestinal bleeding were similar between the 2 treatment groups. Notably, patients in the hydrocortisone group averaged higher daily doses of insulin during the first week of treatment.

After 28 days, the investigators concluded that hydrocortisone reduced the risk of death in ICU patients with severe community-acquired pneumonia.