Dequin PF, et al. N Engl J Med. 2023 Mar 21. doi: 10.1056/NEJMoa2215145.
Question and Methods: Pneumosepsis can lead to pulmonary and systemic inflammation that can increase risk of organ failure and death. The authors attempted to determine if this anti-inflammatory property would be helpful in patients with severe CAP by randomizing patients to receiving hydrocortisone versus placebo.
Findings: The authors found that there was a significant decrease in 28-day mortality in those who received hydrocortisone (6.2%) compared to those receiving placebo (11.9%). There were also significant decreases in secondary outcomes including death at 90 days, rates of intubation, and rates of shock.
Limitations: The study was stopped early despite not reaching their predetermined alpha risk threshold leading to concern of being under-powered and the large treatment being exaggerated. In addition, their stringent inclusion and exclusion criteria makes it difficult to generalize to the ED population (especially exclusion of the patients in shock).
Interpretation: This study will likely not influence our practice in the ED given there are other more time sensitive priorities in these patients. However, it does add to the body of evidence for steroids in patients with signs of systemic inflammation as a consideration when discussing cases with our ICU colleagues.
JC Supervisor: Dr. Krishan Yadav