Hydrocortisone in Severe Community-Acquired Pneumonia

被引：234

作者：

Dequin, Pierre-Francois ^{[1
,2
]}

Meziani, Ferhat ^{[8
,9
]}

Quenot, Jean-Pierre ^{[11
,12
,13
]}

Kamel, T. ^{[14
]}

Ricard, Jean-Damien ^{[15
,19
]}

Badie, Julio ^{[20
]}

Reignier, Jean ^{[21
,22
]}

Heming, Nicholas ^{[23
,24
]}

Plantefeve, Gaetan ^{[25
]}

Souweine, Bertrand ^{[26
]}

Voiriot, Guillaume ^{[16
]}

Colin, Gwenhael ^{[27
]}

Frat, Jean-Pierre ^{[28
,29
]}

Mira, Jean-Paul ^{[17
,18
]}

Barbarot, Nicolas ^{[30
]}

Francois, Bruno ^{[31
,32
]}

Louis, Guillaume ^{[33
]}

Gibot, Sebastien ^{[34
,35
]}

Guitton, Christophe ^{[36
]}

Giacardi, Christophe ^{[37
]}

Hraiech, Sami ^{[40
,41
,42
]}

Vimeux, Sylvie ^{[43
]}

L'Her, Erwan ^{[38
,39
]}

Faure, Henri ^{[44
]}

Herbrecht, Jean-Etienne ^{[10
]}

Bouisse, Camille ^{[45
]}

Joret, Aurelie ^{[46
]}

Terzi, Nicolas ^{[47
,48
]}

Gacouin, Arnaud ^{[49
]}

Quentin, Charlotte ^{[50
]}

Jourdain, Merce ^{[51
,52
]}

Leclerc, Marie ^{[3
]}

Coffre, Carine ^{[3
]}

Bourgoin, Helene ^{[4
]}

Lengelle, Celine ^{[5
]}

Caille-Fenerol, Caroline ^{[53
]}

Giraudeau, Bruno ^{[6
,7
]}

Le Gouge, Amelie ^{[7
]}

机构：

[1] Univ Tours, INSERM, Ctr Study Resp Dis Unite 1100, Med Intens Reanimat, Tours, France

[2] INSERM Ctr Invest Clin 1415, Ctr Hosp Univ CHU, Tours, France

[3] CHU, Delegat Rech Clin & Innovat, Tours, France

[4] CHU, Pharmacie Usage Interne, Tours, France

[5] CHU, Ctr Reg Pharmacovigilance & Informat Medicament, Serv Pharmacosurveillance, Tours, France

[6] Univ Tours, Univ Nantes, INSERM SPHERE Unite 1246, Tours, France

[7] CHU, INSERM Ctr Invest Clin 1415, Tours, France

[8] Univ Strasbourg, Fac Med, INSERM, Unite Mixte Rech 1260,Regenerat Nanomed, Strasbourg, France

[9] Med Intens Reanimat, Med Intens Reanimat Nouvel Hop Civil, Strasbourg, France

[10] Hop Hautepierre, Med Intens Reanimat, Strasbourg, France

[11] Hop Univ Strasbourg, Lipness Team, INSERM Lipids, Nutr,Canc Unite Mixte Rech 1231, Strasbourg, France

[12] Univ Bourgogne, LabEx LipSTIC, INSERM Ctr Invest Clin 1432, Clin Epidemiol, Dijon, France

[13] CHU, Med Intens Reanimat, Dijon, France

[14] Hop Source Orleans, Med Intens Reanimat, Orleans, France

[15] Univ Paris Cite, INSERM Infect Antimicrobials Modeling & Evolut IA, Unite 1137, Paris, France

[16] Sorbonne Univ, Ctr Rech St Antoine Unite Mixte Rech INSERM 938, Med Intens Reanimat, AP HP,Hop Tenon, Paris, France

[17] Univ Paris Cite, Paris, France

[18] Hop Cochin, Med Intens Reanimat, AP HP, Paris, France

[19] DMU ESPRIT, Med Intens Reanimat, Colombes, France

[20] Hop Nord Franche Comte, Reanimat Polyvalente, Trevenans, France

[21] Univ Nantes, Nantes, France

[22] Hop Hotel Dieu, Med Intens Reanimat, Nantes, France

[23] Univ Paris Saclay, Univ Versailles St Quentin, Fac Med Simone Veil, Federat Hosp Univ FHU SEPSIS,INSERM Unite 1173, Garches, France

[24] Hop Raymond Poincare, AP HP, Med Intens Reanimat, Garches, France

[25] CH Victor Dupouy, Reanimat Polyvalente, Argenteuil, France

[26] Univ Clermont Auvergne, Unite Mixte Rech, French Natl Ctr Sci Res CNRS 6023, Lab Microorganismes Genome Environm & Med Intens, Clermont Ferrand, France

[27] Ctr Hosp Dept Vendee, Med Intens Reanimat, La Roche Sur Yon, France

[28] Univ Poitiers, INSERM Ctr Invest Clin 1402, Investigat Sleep Acute Lung Injury & Ventilat, Fac Med & Pharm Poitiers, Poitiers, France

[29] CHU, Med Intens Reanimat, Poitiers, France

[30] Ctr Hosp, Reanimat, St Brieuc, France

[31] Univ Limoges, Unite Mixte Rech 1092, Limoges, France

[32] CHU, INSERM, Ctr Invest Clin & Reanimat Polyvalente 1435, Limoges, France

[33] Ctr Hosp Reg CHR Metz Thionville, Hop Mercy, Reanimat Polyvalente, Metz, France

[34] Univ Lorraine, Nancy, France

[35] CHU, Hop Cent, Med Intens Reanimat, Nancy, France

[36] Hop Le Mans, Reanimat Med Chirurg, Le Mans, France

[37] Hop Instruct Armees Clermont Tonnerre, Reanimat Polyvalente, Brest, France

[38] Univ Bretagne Occidentale, Lab Traitement Informat Med, INSERM, Mixte Rech Unite 1101, Brest, France

[39] CHU Cavale Blanche, Med Intens Reanimat, Brest, France

[40] Aix Marseille Univ, Hlth Serv Res & Qual Life Ctr, Marseille, France

[41] AP HM, Dept Med Informat, Marseille, France

[42] Hop Nord Marseille, AP HM, Med Intens Reanimat, Marseille, France

[43] Ctr Hosp, Reanimat, Montauban, Tarn & Garonne, France

[44] Ctr Hosp Intercommunal Robert Ballanger, Med Intens Reanimat, Aulnay Sous Bois, France

[45] Ctr Hosp, Reanimat, Bourg En Bresse, France

[46] CHU, Med Intens Reanimat, Caen, France

[47] Univ Grenoble Alpes, HP 2, INSERM Unite 1042, Grenoble, France

[48] CHU Grenoble Alpes, Med Intens Reanimat, Grenoble, France

[49] Hop Pontchaillou, Malad Infect & Reanimat Med, Rennes, France

[50] Ctr Hosp, Reanimat, St Malo, France

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2023年 / 388卷 / 21期

关键词：

CORTICOSTEROIDS; THERAPY; FAILURE; PATIENT; ADULTS;

D O I：

10.1056/NEJMoa2215145

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BackgroundWhether the antiinflammatory and immunomodulatory effects of glucocorticoids may decrease mortality among patients with severe community-acquired pneumonia is unclear.MethodsIn this phase 3, multicenter, double-blind, randomized, controlled trial, we assigned adults who had been admitted to the intensive care unit (ICU) for severe community-acquired pneumonia to receive intravenous hydrocortisone (200 mg daily for either 4 or 8 days as determined by clinical improvement, followed by tapering for a total of 8 or 14 days) or to receive placebo. All the patients received standard therapy, including antibiotics and supportive care. The primary outcome was death at 28 days.ResultsA total of 800 patients had undergone randomization when the trial was stopped after the second planned interim analysis. Data from 795 patients were analyzed. By day 28, death had occurred in 25 of 400 patients (6.2%; 95% confidence interval [CI], 3.9 to 8.6) in the hydrocortisone group and in 47 of 395 patients (11.9%; 95% CI, 8.7 to 15.1) in the placebo group (absolute difference, -5.6 percentage points; 95% CI, -9.6 to -1.7; P=0.006). Among the patients who were not undergoing mechanical ventilation at baseline, endotracheal intubation was performed in 40 of 222 (18.0%) in the hydrocortisone group and in 65 of 220 (29.5%) in the placebo group (hazard ratio, 0.59; 95% CI, 0.40 to 0.86). Among the patients who were not receiving vasopressors at baseline, such therapy was initiated by day 28 in 55 of 359 (15.3%) of the hydrocortisone group and in 86 of 344 (25.0%) in the placebo group (hazard ratio, 0.59; 95% CI, 0.43 to 0.82). The frequencies of hospital-acquired infections and gastrointestinal bleeding were similar in the two groups; patients in the hydrocortisone group received higher daily doses of insulin during the first week of treatment.ConclusionsAmong patients with severe community-acquired pneumonia being treated in the ICU, those who received hydrocortisone had a lower risk of death by day 28 than those who received placebo. (Funded by the French Ministry of Health; CAPE COD ClinicalTrials.gov number, .)

引用

页码：1931 / 1941

页数：11

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