COVID-19 research briefs: Hydrocortisone may reduce the need for organ support interventions in critically ill patients

Daily POEMs

Published: 2020-10-31 © 2020 John Wiley & Sons, Inc.

Printer Friendly

Clinical question
Can hydrocortisone improve outcomes for people who are critically ill with COVID-19?

Bottom line
Hydrocortisone likely reduces the need for organ support interventions in critically ill patients with COVID-19 (LOE = 2c)

Reference
The Writing Committee for the REMAP-CAP Investigators. Effect of hydrocortisone on mortality and organ support in patients with severe COVID-19: The REMAP-CAP COVID-19 corticosteroid domain randomized clinical trial. JAMA. Published online September 02, 2020. doi:10.1001/jama.2020.17022.

Study design: Randomized controlled trial (nonblinded)

Allocation: Unconcealed

Setting: Inpatient (ICU only)

Synopsis
Research Brief #62: The REMAP-CAP randomized clinical trials are adaptive trials designed to test several COVID-19 interventions in 121 sites in 8 countries. For the hydrocortisone study, 384 of the 403 enrolled patients critically ill with COVID-19 completed the open-label randomized trial in these 3 groups: fixed-dose hydrocortisone (137), a shock-dependent course (146), and no cortisone (101). The primary outcome was organ support–free days, defined as days alive and free of ICU-based respiratory or cardiovascular support within 21 days. The mean number of organ support–free days was 11.5 for the fixed-dose hydrocortisone group, 9.5 for the shock-dependent hydrocortisone group, and 6 for the no hydrocortisone group. In the Bayesian analysis, there was a 93% probability of superiority for the fixed-dose hydrocortisone over no hydrocortisone and an 80% probability of superiority of shock-dependent dosing of hydrocortisone over no hydrocortisone. The trial was stopped early because of the publication of the positive results from the RECOVERY trial (June 16, 2020), since the investigators felt there was no longer a clinical equipoise and that hydrocortisone should not be withheld from patients who are critically ill with COVID-19. A meta-analysis published simultaneously with this study confirms the benefit of corticosteroids for severe COVID-19 infection.

John Hickner, MD, MS
Professor Emeritus
Dept of Family Medicine
Michigan State University
East Lansing, MI

Copyright © 2020 John Wiley & Sons, Inc.