RecentRCT

REMAP-CAP fixed-course hydrocortisone

Effect of hydrocortisone on mortality in patients with severe community-acquired pneumonia : The REMAP-CAP Corticosteroid Domain Randomized Clinical Trial.

Intensive Care Medicine, 2025 · International adaptive platform trial; fixed-course arm stopped for futility

Population: 658 severe-CAP adults randomized; 536 hydrocortisone and 122 control; 15 missing day-90 status
Intervention: Hydrocortisone 50 mg IV q6h for seven days
Comparator: No corticosteroid
Primary outcome: 90-day all-cause mortality
Result: 15% versus 9.8% among those with status; adjusted ORs 1.52–1.63 across strata, all 95% credible intervals crossing 1.

What the trial found

A large mortality benefit was unlikely; smaller benefit and harm remained possible.

Clinical interpretation

Reconcile with CAPE COD and phenotype-specific guidance; this was not proof of equivalence or universal steroid harm.

Moderate certainty

Clinical Context & Relevant Topics (1)

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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