Scholarlink

Purpose <p>To determine whether hydrocortisone improves mortality in severe community-acquired pneumonia (CAP).</p> Methods <p>In an international adaptive randomized controlled platform trial testing multiple interventions, adults admitted to the intensive care unit (ICU) with severe CAP were randomized to a 7-day course of intravenous hydrocortisone (50&#xa0;mg every 6&#xa0;h) or control (no corticosteroid). The primary end point was 90-day all-cause mortality, analyzed iteratively by a Bayesian hierarchical model estimating distinct treatment effects for patients presenting with influenza (Y/N) and shock (Y/N).</p> Results <p>Fixed 7-day course hydrocortisone enrollment was stopped for futility (&lt; 5% probability of &gt; 20% relative improvement). Of 658 patients enrolled, 536 were randomized to hydrocortisone and 122 to control. Vital status at day 90 was missing for 15 patients. Day 90 mortality was 15% (78/521) and 9.8% (12/122) for the hydrocortisone and control groups. The adjusted odds ratio ranged from 1.52 to 1.63 (with all 95% CrI crossing 1), while the probability of &gt; 20% relative reduction of day 90 mortality ranged from 7.1 to 3.3% across influenza and shock strata. Results were consistent in sensitivity and pre-specified secondary outcomes. In exploratory analyses, the duration of shock appeared lower in the hydrocortisone group compared with control (median (IQR) of 2 (2–5) days compared to control 3 (2–6.75) days, <i>p</i> value = 0.05).</p> Conclusions <p>Among patients with severe CAP, treatment with a 7-day course of hydrocortisone, compared with no hydrocortisone, appears unlikely to yield a large reduction in mortality. Smaller benefits and possible harm are not excluded.</p> Trial registration <p>Clinicaltrials.gov identifier: NCT02735707 (registration date: November 4th, 2016).</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Effect of hydrocortisone on mortality in patients with severe community-acquired pneumonia

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年4月22日

查看全文
  • Nicholas Heming,
  • Lindsay Berry,
  • Elizabeth Lorenzi,
  • Thomas E. Hills,
  • Alisa M. Higgins,
  • Yaseen Arabi,
  • Diptesh Aryal,
  • Abigail Beane,
  • Janis Best-Lane,
  • Marc Bonten,
  • Charlotte Bradbury,
  • Frank Brunkhorst,
  • Aidan Burrell,
  • Meredith Buxton,
  • Maurizio Cecconi,
  • James D. Chalmers,
  • Allen C. Cheng,
  • Graham Cooke,
  • Matthew E. Cove,
  • Paul Dark,
  • Lennie Derde,
  • Michelle A. Detry,
  • Lise J. Estcourt,
  • Mark Fitzgerald,
  • Anthony C. Gordon,
  • Cameron Green,
  • Rashan Haniffa,
  • Madiha Hashmi,
  • Leanne Hays,
  • Christopher Horvat,
  • David T. Huang,
  • Nao Ichihara,
  • Devachandran Jayakumar,
  • Peter S. Kruger,
  • Francois Lamontagne,
  • Patrick R. Lawler,
  • Roger J. Lewis,
  • Edward Litton,
  • John C. Marshall,
  • Colin J. McArthur,
  • Daniel F. McAuley,
  • Anna McGlothlin,
  • Shay McGuinness,
  • Zoe McQuilten,
  • Bryan J. McVerry,
  • Susan C. Morpeth,
  • Paul R. Mouncey,
  • Alistair D. Nichol,
  • Rachael L. Parke,
  • Jane C. Parker,
  • Svenja Peters,
  • Padmanabhan Ramnarayan,
  • Luis Felipe Reyes,
  • Kathryn M. Rowan,
  • Hiroki Saito,
  • Marlene S. Santos,
  • Christina T. Saunders,
  • Christopher Seymour,
  • Manu Shankar-Hari,
  • Vanessa Singh,
  • Paul A. Tambyah,
  • Alexis F. Turgeon,
  • Anne M. Turner,
  • Andrew Ustianowski,
  • Frank L. van de Veerdonk,
  • Alicia A. C. Waite,
  • Elizabeth Whittaker,
  • Ryan Zarychanski,
  • Srinivas Murthy,
  • Steven A. Webb,
  • Scott Berry,
  • Balasubramanian Venkatesh,
  • Djillali Annane,
  • Derek C. Angus

摘要

Purpose

To determine whether hydrocortisone improves mortality in severe community-acquired pneumonia (CAP).

Methods

In an international adaptive randomized controlled platform trial testing multiple interventions, adults admitted to the intensive care unit (ICU) with severe CAP were randomized to a 7-day course of intravenous hydrocortisone (50 mg every 6 h) or control (no corticosteroid). The primary end point was 90-day all-cause mortality, analyzed iteratively by a Bayesian hierarchical model estimating distinct treatment effects for patients presenting with influenza (Y/N) and shock (Y/N).

Results

Fixed 7-day course hydrocortisone enrollment was stopped for futility (< 5% probability of > 20% relative improvement). Of 658 patients enrolled, 536 were randomized to hydrocortisone and 122 to control. Vital status at day 90 was missing for 15 patients. Day 90 mortality was 15% (78/521) and 9.8% (12/122) for the hydrocortisone and control groups. The adjusted odds ratio ranged from 1.52 to 1.63 (with all 95% CrI crossing 1), while the probability of > 20% relative reduction of day 90 mortality ranged from 7.1 to 3.3% across influenza and shock strata. Results were consistent in sensitivity and pre-specified secondary outcomes. In exploratory analyses, the duration of shock appeared lower in the hydrocortisone group compared with control (median (IQR) of 2 (2–5) days compared to control 3 (2–6.75) days, p value = 0.05).

Conclusions

Among patients with severe CAP, treatment with a 7-day course of hydrocortisone, compared with no hydrocortisone, appears unlikely to yield a large reduction in mortality. Smaller benefits and possible harm are not excluded.

Trial registration

Clinicaltrials.gov identifier: NCT02735707 (registration date: November 4th, 2016).