Historical collection · First published Apr 22, 2025; added to EM Weekly Oct 27, 2026. This retrospective summary may be superseded by later evidence or guidance.
← All articlesEffect of hydrocortisone on mortality in patients with severe community-acquired pneumonia: The REMAP-CAP Corticosteroid Domain Randomized Clinical Trial
Summary
This adaptive platform comparison assigned 658 ICU patients with severe CAP to hydrocortisone 50 mg IV every 6 hours for 7 days or no corticosteroid. Enrollment stopped for futility. Ninety-day mortality was 15.0% versus 9.8%; stratum-specific adjusted ORs were 1.52–1.63, with all 95% credible intervals crossing 1.
Why it matters
Complicates the assumption that every severe-CAP steroid regimen produces the same benefit. This tested regimen does not by itself invalidate other regimens or current guideline-directed care.
Study at a glance
- Design
- Randomized trial
- Population
- Adults admitted to ICU with severe community-acquired pneumonia.
- Sample size
- 658
- Intervention
- Fixed 7-day IV hydrocortisone, 50 mg every 6 hours.
- Comparator
- No corticosteroid.
- Primary endpoint
- All-cause mortality at 90 days, stratified by influenza and shock.
Main findings
- Mortality: 78/521 versus 12/122.
- Stopping criterion: <5% probability of a >20% relative mortality improvement.
Limitations
The control arm was small (122 patients), 15 outcomes were missing, and Bayesian estimates were imprecise. Smaller benefits and harm remain possible; adverse-event detail was not verified beyond the abstract.
Read the primary source
Full text: Open-access full text available.
Original sourceDOI: 10.1007/s00134-025-07861-w
PMID: 40261382
Material reviewed: abstract.
Source retrieved Oct 27, 2026. Historical backfill. Primary abstract reviewed; full article not reviewed. Publisher correction of June 16, 2025 reviewed: corresponding author was erroneously listed as an additional author; no result correction stated. Correction: https://link.springer.com/article/10.1007/s00134-025-07954-6
Corrections & review history
No corrections recorded. Human review: not yet human-reviewed.