A groundbreaking study funded by the French Ministry of Health and published in the New England Journal of Medicine has discovered that administering hydrocortisone, a steroid, to patients with severe pneumonia can significantly decrease the risk of death.
The research, which randomly assigned 800 intensive care unit (ICU) patients to receive either hydrocortisone or a placebo, demonstrated a remarkable reduction in mortality rates among the hydrocortisone group. These findings challenge current treatment guidelines and potentially revolutionize the approach to caring for ICU patients with community-acquired pneumonia.
The study, led by Professor Pierre-François Dequin from the University of Tours, randomly assigned 800 ICU patients to receive either hydrocortisone or a placebo. Within the hydrocortisone group, approximately 6% of patients died within 28 days, while the placebo group experienced a mortality rate of about 12% during the same timeframe. The absolute reduction in deaths of 5.6% was statistically significant and highlighted the potential survival benefits of hydrocortisone.
Professor Dequin, the study’s lead author, emphasized that these findings should transform medical care practices. This study is particularly noteworthy as it diverges from the norm of pharmaceutical studies, which are often funded by drug manufacturers and focus on patented medications.
Instead, this government-funded randomized trial explored the effectiveness of an inexpensive generic drug, hydrocortisone. Dr. David Boulware from the University of Minnesota Medical School believes these results should fundamentally change how doctors treat ICU patients with community-acquired pneumonia.
The study’s outcomes challenge current treatment guidelines, which discourage the use of corticosteroids in community-acquired pneumonia due to concerns regarding immune system suppression. Dr. Paul Sax, clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital in Boston, acknowledged that these results would “challenge” the existing guidelines. The positive findings associated with hydrocortisone suggest a need to reevaluate the approach to corticosteroid usage in severe pneumonia cases.
In addition to the reduced mortality rate, the study revealed other notable benefits of hydrocortisone treatment. Among the patients not on mechanical ventilators, those who received the placebo had a higher rate of intubation at 29.5%, compared to 18% in the hydrocortisone group, signifying a 41% reduction in the risk of intubation. Furthermore, there was a 40% decrease in patients requiring vasopressor drugs in the hydrocortisone group.
The use of corticosteroids for pneumonia treatment has long been debated among medical professionals. Dexamethasone, another steroid, was one of the first drugs found to reduce mortality rates in severe Covid-19 cases.
Although a separate study led by Dequin explored hydrocortisone’s effects on Covid-19 patients, it was discontinued due to the success of dexamethasone. Nevertheless, the pneumonia study conducted during the pandemic yielded results unaffected by Covid-19, as confirmed by a statistical analysis comparing outcomes before and after the pandemic began.
The study excluded patients with influenza due to evidence suggesting potential harm from steroids in such cases. Professor Dequin advised against starting steroid treatment for patients with influenza and recommended its discontinuation if influenza is detected.
Despite the conflicting results in previous studies, the growing body of evidence supports hydrocortisone’s “selective and judicious” use in ICU-admitted patients with severe pneumonia, especially those over 65 with low blood oxygen levels. Further studies are warranted to assess the safety of steroids, as they have been associated with sepsis, bleeding, and neuropsychiatric side effects.
