Trial reportIntensive care medicine2025
Effect of hydrocortisone on mortality in patients with severe community-acquired pneumonia : The REMAP-CAP Corticosteroid Domain Randomized Clinical Trial.
Trial report in Intensive care medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT02735707 (Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community- Acquired Pneumonia), which is not on this map. Cited by 43 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community- Acquired Pneumonia
Who cites it
43 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Efficacy of higher-dose versus lower-dose corticosteroids in community-acquired pneumonia: a systematic review and network meta-analysis.Critical care (London, England) · 2026Pooled it
- A Pragmatic Trial of Glucocorticoids for Community-Acquired Pneumonia.The New England journal of medicine · 2025Trial
- Lymphopenia and elevated NLR identify patients with septic shock who may benefit from corticosteroids: a target trial emulation study.Intensive care medicine experimental · 2026Article
- Ventilatory Parameters and Adjunctive Therapies Associated with ICU Mortality in Severe Pneumonia: A Large Retrospective Cohort Study.Journal of clinical medicine · 2026Article
- Mineralocorticoid magic? Evaluating fludrocortisone in septic shock.British journal of clinical pharmacology · 2026Review
- A clinician's guide to corticosteroid therapy in pneumonia and critical illness: agent selection, dosing, monitoring, and interactions.Pneumonia (Nathan Qld.) · 2026Review
- Navigating the Future of Respiratory Infections: Key Insights From International Congress in Singapore, 17-20 September 2025.Influenza and other respiratory viruses · 2026Article
- Use of corticosteroids in sepsis and infectious diseases: a narrative review.The Korean journal of internal medicine · 2026Review
- Corticosteroids in immunocompromised ICU patients with pneumonia: risks, evidence, and clinical practice.Pneumonia (Nathan Qld.) · 2026Review
- Pulmonary inflammation in severe pneumonia is characterised by compartmentalised and mechanistically distinct sub-phenotypes.Nature communications · 2026Article
- Challenges and opportunities in the management of severe pneumonia. Key concepts from the Seventh Annual Meeting of Spanish Experts 2025.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2026Review
- Managing sepsis in the era of precision medicine: a narrative review.Acute and critical care · 2026Article
- Adjunctive betamethasone treatment of hypoxaemic adults hospitalised withThe Lancet regional health. Europe · 2026Article
- Corticosteroids forThe Lancet regional health. Europe · 2026Article
- The heterogeneous treatment effect of adjuvant therapy with corticosteroids in patients with Community-Acquired Pneumonia: a review.Pneumonia (Nathan Qld.) · 2026Review
- Therapy as a State-Generator: Dynamic Phenotypic Landscapes and Adaptive Stress Circuits in Chemotherapy Resistance of Breast Cancer.Antioxidants (Basel, Switzerland) · 2026Review
- Non-antimicrobial interventions in recovery from community-acquired pneumonia in adults.Current opinion in infectious diseases · 2026Review
- Systemic corticosteroids for severe community-acquired pneumonia: a narrative review of mechanisms and critical appraisal of recent trials in ICU.European respiratory review : an official journal of the European Respiratory Society · 2026Review
- Update on infection: from prevention to diagnosis and management.Intensive care medicine · 2026Article
- Efficacy of anakinra in reducing progression to organ dysfunction in patients with pneumonia (INSPIRE): a randomised, double-blind, placebo-controlled, phase IIa trial.The Lancet regional health. Europe · 2026Article
Corrections and comments
- Erratum issued
Authors and funding
2 authors.
Funding
Abstract
purposeTo determine whether hydrocortisone improves mortality in severe community-acquired pneumonia (CAP).
methodsIn an international adaptive randomized controlled platform trial testing multiple interventions, adults admitted to the intensive care unit (ICU) with severe CAP were randomized to a 7-day course of intravenous hydrocortisone (50 mg every 6 h) or control (no corticosteroid). The primary end point was 90-day all-cause mortality, analyzed iteratively by a Bayesian hierarchical model estimating distinct treatment effects for patients presenting with influenza (Y/N) and shock (Y/N).
resultsFixed 7-day course hydrocortisone enrollment was stopped for futility (< 5% probability of > 20% relative improvement). Of 658 patients enrolled, 536 were randomized to hydrocortisone and 122 to control. Vital status at day 90 was missing for 15 patients. Day 90 mortality was 15% (78/521) and 9.8% (12/122) for the hydrocortisone and control groups. The adjusted odds ratio ranged from 1.52 to 1.63 (with all 95% CrI crossing 1), while the probability of > 20% relative reduction of day 90 mortality ranged from 7.1 to 3.3% across influenza and shock strata. Results were consistent in sensitivity and pre-specified secondary outcomes. In exploratory analyses, the duration of shock appeared lower in the hydrocortisone group compared with control (median (IQR) of 2 (2-5) days compared to control 3 (2-6.75) days, p value = 0.05).
conclusionsAmong patients with severe CAP, treatment with a 7-day course of hydrocortisone, compared with no hydrocortisone, appears unlikely to yield a large reduction in mortality. Smaller benefits and possible harm are not excluded.
trial registrationClinicaltrials.gov identifier: NCT02735707 (registration date: November 4th, 2016).
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.