Intravenous hydrocortisone reduces all-cause mortality in severe community-acquired pneumonia (CAPE COD)

Clinical Question

For patients with severe community-acquired pneumonia, does hydrocortisone improve outcomes?

Bottom line

This study found a clear mortality benefit for intravenous hydrocortisone in patients with severe CAP, without any worrisome adverse effects such as an increase in infections. Another July 2023 POEM presents a systematic review that found a reduction in the need for ICU admission or mechanical ventilation, but no impact on mortality. However, the bulk of the studies in that analysis were in hospitalized patients without severe pneumonia. 1b

Study design: Randomized controlled trial (double-blinded)

Funding: Government

Setting: Inpatient (ICU only)


Mark H. Ebell, MD, MS
University of Georgia
Athens, GA

Discuss this POEM



Impact assessment



Steroids in CAP

Severe cases of CAP seem more common lately. I have known two who had no real risk factors, c one in ICU for weeks and another in and out of ICU and then died. Whatever helps is welcome. Also need information on Vitamin D and reduction of "cytokine storm".

James Duncan Stephenson


This is the same drug my hospital pharmacy today told me is “short”

Pieter Richard Verbeek

IV HC for severe CAP

Impressive results. From a study perspective it made sense to include on ICU patients however not all patients with severe CAP are admitted to the ICU. I would expect that there will be a significant "indication creep" wrt use of IV HC in patients.


severe CAP in hospitalized pts

IV hydrocortisone reduces mortality