RCT

CAPE COD

Hydrocortisone in Severe Community-Acquired Pneumonia

NEJM, 2023 · Phase 3 multicenter double-blind randomized placebo-controlled trial (n=800)

Clinical question

Does early hydrocortisone reduce 28-day mortality in severe community-acquired pneumonia admitted to the ICU?

Population: Adults with severe CAP admitted to the ICU meeting severity criteria
Intervention: Continuous IV Hydrocortisone (200 mg daily for 4-8 days)
Comparator: Placebo infusion
Primary outcome: 28-day all-cause mortality
Result: 28-day mortality was 6.2% in the hydrocortisone group compared to 11.9% in the placebo group (absolute difference -5.6%; 95% CI, -9.6 to -1.7; P=0.006).

What the trial found

Early continuous hydrocortisone reduced 28-day mortality by nearly half in severe CAP without increasing secondary infections.

Current guideline position

Supported in critical care pneumonia management.

Clinical interpretation

Solidified early adjunctive hydrocortisone as a mortality-reducing intervention in severe CAP.

Clinical Context & Relevant Topics (2)

Disease Reference

Severe Community-Acquired Pneumonia (Severe CAP)

IDSA/ATS severe CAP criteria, rapid microbiology, targeted empiric antimicrobial regimens, and landmark adjunctive hydrocortisone evidence (CAPE COD).

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Sepsis

Life-threatening organ dysfunction caused by a dysregulated host response to infection — recognized by an acute rise in SOFA score, not by infection plus fever alone.

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