Hydrocortisone linked to lower risk for death in severe pneumonia (Almost 50% less)

Medical Xpress / HealthDay / New England Journal of Medicine ^ | March 23, 2023 | Elana Gotkine / Pierre-François Dequin et al

[ConservativeMind]

For patients with severe community-acquired pneumonia admitted to the intensive care unit (ICU), hydrocortisone is associated with a lower risk for death by day 28, according to a study.

Pierre-François Dequin, M.D., Ph.D. and colleagues conducted a phase 3 trial involving adults who had been admitted to the ICU for severe community-acquired pneumonia to assess whether early treatment with hydrocortisone reduced mortality at 28 days. Participants were randomly assigned to receive intravenous hydrocortisone (200 mg daily for four or eight days, as determined by clinical improvement, followed by tapering for a total of eight or 14 days) or placebo. All participants also received standard therapy, including antibiotics and supportive care.

The trial was stopped after the second planned interim analysis when 800 patients had undergone randomization; 795 were included in the analyses (400 in the hydrocortisone group and 395 in the placebo group). The researchers found that death had occurred in 6.2 and 11.9 percent of patients in the hydrocortisone and placebo groups, respectively, by day 28. Among patients not undergoing mechanical ventilation at baseline, endotracheal intubation was performed in 18.0 and 29.5 percent in the hydrocortisone and placebo groups, respectively (hazard ratio, 0.59).

For patients not receiving vasopressors at baseline, the therapy was initiated in 15.3 and 25.0 percent in the hydrocortisone and placebo groups, respectively, by day 28 (hazard ratio, 0.59). The groups had similar frequencies of hospital-acquired infections and gastrointestinal bleeding.

"Early treatment with hydrocortisone reduced 28-day mortality among patients who had been admitted to the ICU with severe community-acquired pneumonia," the authors write.

[ConservativeMind]

This initially tells me it’s not been fully understood that pneumonia, or something concurrent with it, is most deadly due to over-inflammation, not unlike what can happen with sepsis.

[ConservativeMind]

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[Cold Heart]

Thanks.

[spintreebob]

Was there a control group that received the same level of attention? Or was there a Hawthorne effect involved?

When a study is being performed, the people in the study receive more attention than normal. People love attention. Attention has a positive impact on the health of most people.

So there needs to be an equal amount of attention to the control group that receives the same attention with those giving attention blind to the fact that they are giving placebo.

[ConservativeMind]

I think your concern around attention is misguided, because they were all in ICUs.

However, this shows that even the doctors didn't know. From the study:

“In this phase 3, multicenter, double-blind, randomized, controlled trial,…”

[Pete from Shawnee Mission]

"This initially tells me it’s not been fully understood that pneumonia, or something concurrent with it, is most deadly due to over-inflammation, not unlike what can happen with sepsis."

Thank you! Throw in some Vitamin C to the next study. Almost HAT therapy. Add Benedryl, Prevacid, Prilosec and an antibiotic.