Hydrocortisone in Severe Community-Acquired Pneumonia

To the Editor: In their article on the Community-Acquired Pneumonia: Evaluation of Corticosteroids (CAPE COD) trial, Dequin et al. (May 25 issue)(1) report an almost 50% lower 28-day mortality in the hydrocortisone group (6.2%) than in the placebo group (11.9%). Although patients with septic shock were initially excluded, septic shock occurred more commonly in the placebo group (in 25% of the patients) than in the hydrocortisone group (in 15%) after randomization. The use of open-label glucocorticoids was not permitted in this trial, and this may have contributed to the higher mortality observed in the placebo group.(2) Another recent, similarly sized . . .