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Hydrocortisone in Severe Community-Acquired Pneumonia
Pierre-François Dequin1, Ferhat Meziani1, Jean-Pierre Quenot1
1From Université de Tours, INSERM, Center for the Study of Respiratory Diseases Unité 1100, Médecine Intensive-Réanimation and INSERM Centre d'Investigation Clinique 1415, Centre Hospitalier Universitaire (CHU) (P.-F.D.), Délégation à la Recherche Clinique et à l'Innovation, CHU (M.L., C.C.), Pharmacie à Usage Interne, CHU (H.B.), Centre Régional de Pharmacovigilance et d'Information sur le Médicament, Service de Pharmacosurveillance, CHU (C.L.), Université de Tours, Université de Nantes, INSERM SPHERE Unité 1246 (B.G.), and INSERM Centre d'Investigation Clinique 1415, CHU (B.G., A.L.G.), Tours, INSERM, Unité Mixte de Recherche 1260, Regenerative Nanomedicine, Université de Strasbourg, Faculté de Médecine, and Médecine Intensive-Réanimation Nouvel Hôpital Civil (F.M.), Médecine Intensive Réanimation, Hôpital de Hautepierre (J.-E.H.), Hôpitaux Universitaires de Strasbourg, Strasbourg, the Lipness Team, INSERM Lipids, Nutrition, Cancer-Unité Mixte de Recherche 1231 and LabEx LipSTIC, INSERM Centre d'Investigation Clinique 1432, Clinical Epidemiology, Université de Bourgogne, and Médecine Intensive Réanimation, CHU (J.-P.Q.), Dijon, Médecine Intensive Réanimation, Hôpital de la Source, Orléans (T.K.), INSERM Infection, Antimicrobials, Modeling, and Evolution (IAME) Unité 1137, Université Paris Cité (J.-D.R.), Sorbonne Université, Centre de Recherche Saint-Antoine Unité Mixte de Recherche 938 INSERM, Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon (G.V.), and Université Paris Cité, Paris, Médecine Intensive Réanimation, AP-HP, Hôpital Cochin (J.-P.M.), Médecine Intensive Réanimation, DMU ESPRIT, Colombes (J.-D.R.), Réanimation Polyvalente, Hôpital Nord Franche-Comté, Trévenans (J.B.), Université de Nantes et Médecine Intensive-Réanimation, Hôtel-Dieu, Nantes (J.R.), Fédération Hospitalo Universitaire (FHU) SEPSIS, INSERM Unité 1173, Faculté de Médecine Simone Veil, Université Versailles Saint Quentin, Université de Paris Saclay, and Médecine Intensive-Réanimation, AP-HP, Hôpital Raymond Poincaré (N.H.), Garches, Réanimation Polyvalente, CH Victor Dupouy, Argenteuil (G.P.), Université Clermont Auvergne Unité Mixte de Recherche, French National Center for Scientific Research (CNRS) 6023, Laboratoire Microorganismes: Génome Environnement and Médecine Intensive Réanimation, CHU Clermont-Ferrand, Clermont-Ferrand (B.S.), Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendée, La Roche-Sur-Yon (G.C.), INSERM Centre d'Investigation Clinique 1402, Investigations of Sleep, Acute Lung Injury, and Ventilation, Université de Poitiers, Faculté de Médecine et de Pharmacie de Poitiers, and Médecine Intensive Réanimation, CHU (J.-P.F.), Poitiers, Réanimation, Centre Hospitalier, Saint Brieuc (N.B.), Unité Mixte de Recherche 1092, Université, Limoges, and INSERM Centre d'Investigation Clinique 1435 and Réanimation Polyvalente, CHU (B.F.), Limoges, Réanimation Polyvalente, Hôpital de Mercy, Centre Hospitalier Régional (CHR) Metz-Thionville, Metz (G.L.), Université de Lorraine, and Médecine Intensive Réanimation, Hôpital Central, CHU, Nancy (S.G.), Réanimation Médico-Chirurgicale, Hôpital, Le Mans (C. Guitton), Réanimation Polyvalente, Hôpital d'Instruction des Armées Clermont Tonnerre (C. Giacardi), Laboratoire de Traitement de l'Information Médicale INSERM Mixte de Recherche Unité 1101, Université de Bretagne Occidentale (E.L.), and Médecine Intensive Réanimation, CHU de la Cavale Blanche (E.L.), Brest, Aix-Marseille Université, Health Service Research and Quality of Life Center, the Department of Medical Information, Assistance Publique-Hopitaux de Marseille (AP-HM), Marseille, and Médecine Intensive-Réanimation, AP-HM, Hôpital Nord, Marseille (S.H.), Réanimation, Centre Hospitalier, Montauban (S.V.), Médecine Intensive Réanimation, Centre Hospitalier Intercommunal Robert Ballanger, Aulnay-Sous-Bois (H.F.), Réanimation, Centre Hospitalier, Bourg-en-Bresse (C.B.), Médecine Intensive Réanimation, CHU, Caen (A.J.), INSERM Unité 1042, HP-2, Université Grenoble-Alpes, and Médecine Intensive Réanimation, CHU Grenoble Alpes, Grenoble (N.T.), Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Rennes (A.G.), Réanimation, Centre Hospitalier, Saint-Malo (C.Q.), INSERM Unité 1190, Université de Lille, and the Département de Réanimation, Hôpital Roger Salengro, CHU, Lille (M.J.), and INSERM Centre d'Investigation Clinique 1435, CHU, Limoges (C.C.-F.) - all in France.
Hydrocortisone treatment significantly reduced 28-day mortality in severe community-acquired pneumonia patients admitted to the intensive care unit (ICU). This finding offers a potential new therapeutic strategy for critical pneumonia cases.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pharmacology
Background:
- Severe community-acquired pneumonia (CAP) poses a significant mortality risk.
- The efficacy of anti-inflammatory and immunomodulatory agents like glucocorticoids in severe CAP is not well-established.
Purpose of the Study:
- To investigate the effect of intravenous hydrocortisone on mortality in patients with severe CAP requiring intensive care unit (ICU) admission.
Main Methods:
- A phase 3, multicenter, double-blind, randomized controlled trial was conducted.
- Adults with severe CAP in the ICU received either intravenous hydrocortisone or placebo, alongside standard care.
- The primary outcome was 28-day mortality.
Main Results:
- Death by day 28 occurred in 6.2% of the hydrocortisone group versus 11.9% in the placebo group, a statistically significant reduction.
- Hydrocortisone use was associated with a lower rate of mechanical ventilation and vasopressor initiation.
- No significant differences were observed in hospital-acquired infections or gastrointestinal bleeding between groups.
Conclusions:
- Intravenous hydrocortisone administration significantly reduced 28-day mortality in patients with severe community-acquired pneumonia treated in the ICU.
- Hydrocortisone may be a beneficial adjunctive therapy for severe CAP, reducing the need for mechanical ventilation and vasopressors.
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