CAPE-COD Trial Hydrocortisone Protocol
The CAPE-COD trial used intravenous hydrocortisone 200 mg daily for either 4 or 7 days (based on clinical improvement), followed by tapering for a total treatment duration of 8 or 14 days. 1
Dosing Details
The specific protocol administered hydrocortisone as follows:
- Initial phase: 200 mg IV daily for 4-7 days depending on clinical improvement 1
- Tapering phase: Gradual dose reduction after the initial phase 1
- Total duration: 8 days (if initial phase was 4 days) or 14 days (if initial phase was 7 days) 1
Patient Population
The trial enrolled adults admitted to intensive care units or intermediate-care units with severe community-acquired pneumonia 1. All patients received standard therapy including antibiotics and supportive care alongside the hydrocortisone or placebo 1.
Clinical Outcomes
This dosing regimen demonstrated significant mortality benefit:
- 28-day mortality: 6.2% in the hydrocortisone group versus 11.9% in placebo (absolute difference -5.6 percentage points, P=0.006) 1
- Reduced intubation rates: Among non-ventilated patients at baseline, 18.0% required intubation with hydrocortisone versus 29.5% with placebo 1
- Reduced vasopressor use: Among patients not on vasopressors at baseline, 15.3% required them with hydrocortisone versus 25.0% with placebo 1
Important Safety Considerations
The main adverse effect was hyperglycemia requiring higher insulin doses during the first week of treatment 1. Hospital-acquired infections and gastrointestinal bleeding rates were similar between groups 1.