6/28/23, 12:02 AM CAPE COD Pathway Feedback Search Clinical Topics Home Studies CAPE COD CAPE COD Disease Community-acquired pneumonia Trial question What is the role of hydrocortisone in severe community-acquired pneumonia? Study design Multi-center Double blinded RCT Population Characteristics of study participants 31.0% female N = 795 69.0% male 795 patients (243 female, 552 male) Inclusion criteria: adults who had been admitted to the ICU for severe community-acquired pneumonia Key exclusion criteria: do-not-intubate order; pneumonia caused by influenza; and septic shock Interventions N=400 hydrocortisone (200 mg daily for either 4 or 8 days as determined by clinical improvement, followed by tapering for a total of 8 or 14 days) N=395 placebo (matching placebo) Primary outcome Death at day 28 11.9 % 11.9 8.9 % https://web.pathway.md/studies/recsRlfT36t9jujAM 1/2 6/28/23, 12:02 AM CAPE COD Pathway 6.2 6.0 % Significant decrease 3.0 % NNT = 18 0.0 % Hydrocortisone Placebo Significant decrease in death at day 28 (6.2% vs. 11.9%; ARD -5.6, 95% CI -9.6 to -1.7) Secondary outcomes Borderline significant decrease in the rate of endotracheal intubation by day 28 in patients not undergoing mechanical ventilation at baseline (18% vs. 29.5%; HR 0.59, 95% CI 0.4 to 0.86) Borderline significant decrease in the rate of endotracheal intubation by day 28 in patients not receiving endotracheal intubation at baseline (19.5% vs. 27.7%; HR 0.69, 95% CI 0.5 to 0.94) Borderline significant decrease in the rate of vasopressors initiation by day 28 in patients not receiving vasopressor at baseline (15.3% vs. 25%; HR 0.59, 95% CI 0.43 to 0.82) Safety outcomes No significant differences in composite of hospital-acquired infection, gastrointestinal bleeding, weight change. Significant difference in median daily dose of insulin by day 7 in patients receiving insulin therapy (35.5 IU/day vs. 20.5 IU/day). Conclusion In adults who had been admitted to the ICU for severe community-acquired pneumonia, hydrocortisone was superior to placebo with respect to death at day 28. Reference Pierre-Fran ois Dequin, Ferhat Meziani, Jean-Pierre Quenot et al. Hydrocortisone in Severe Community-Acquired Pneumonia. N Engl J Med. 2023 May 25;388(21):1931-1941. Open reference URL https://web.pathway.md/studies/recsRlfT36t9jujAM 2/2