Hydrocortisone in Severe Community-Acquired Pneumonia (CAPE COD)

The role of corticosteroids in CAP had been debated for decades with conflicting results. CAPE COD was a well-designed trial specifically targeting severe CAP (ICU admission) with adequate power.

Multicenter RCT (27 French ICUs, n=800) comparing hydrocortisone (200 mg/day continuous infusion for 4–8 days, then tapered) vs. placebo in patients with severe CAP (PSI class V or ICU admission).

28-day mortality was significantly lower with hydrocortisone (6.2% vs 11.9%, p=0.006). Hydrocortisone also reduced need for mechanical ventilation and vasopressors. No increase in superinfections.

Hydrocortisone 200 mg/day should be considered in severe CAP requiring ICU admission. This led to updated SCCM 2024 guidelines recommending corticosteroids in severe CAP. Know the 2024 SCCM guideline update.

French ICU population — may not generalize. Excluded immunocompromised patients. Mortality in control arm was higher than expected.