title: Impact of systemic corticosteroids on the clinical course and outcomes of patients with severe community-acquired pneumonia: a cohort study.
abstract: BACKGROUND
  Our aim was to evaluate the impact of corticosteroids on clinical course and outcomes of patients with severe community-acquired pneumonia (CAP) requiring invasive mechanical ventilation.
  
  
  METHODS
  This was a cohort study of patients with severe CAP from 2 intensive care units in tertiary hospitals in Brazil and Portugal.
  
  
  RESULTS
  A total of 111 patients were included (median age, 69 years; 56% men; 34% hospital mortality). Corticosteroids were prescribed in 61 (55%) patients. Main indications for their use were bronchospasm (52.5%) and septic shock (36%). Mortality rate of patients treated with and without corticosteroids was comparable (29.5% vs 32%, P = .837). No significant differences were observed on clinical course from day 1 to day 7 as assessed by the Sequential Organ Failure Assessment score (P = .95). Furthermore, C-reactive protein declined similarly in both groups (P = .147). In a multivariate analysis, mortality was associated with older age and higher Acute Physiology and Chronic Health Evaluation II score.
  
  
  CONCLUSIONS
  In patients with severe CAP requiring invasive mechanical ventilation, adjunctive therapy with corticosteroids did not influence intensive care unit and hospital mortality. In addition, no changes were observed on weaning from vasopressors, on recovery from organ failure/dysfunction as assessed by the Sequential Organ Failure Assessment score, as well as on C-reactive protein course.
authors.affiliation: Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil. jorgesalluh@yahoo.com.br
authors.forename: Jorge I F
authors.initials: JI
authors.lastname: Salluh
authors.forename: Márcio
authors.initials: M
authors.lastname: Soares
authors.forename: Luis M
authors.initials: LM
authors.lastname: Coelho
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Bozza
authors.forename: Juan Carlos R
authors.initials: JC
authors.lastname: Verdeal
authors.forename: Hugo C
authors.initials: HC
authors.lastname: Castro-Faria-Neto
authors.forename: José Roberto Lapa
authors.initials: JR
authors.lastname: e Silva
authors.forename: Patrícia T
authors.initials: PT
authors.lastname: Bozza
authors.forename: Pedro
authors.initials: P
authors.lastname: Póvoa
mesh_terms: D018806:APACHE; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000367:Age Factors; D000368:Aged; D001938:Brazil; D002097:C-Reactive Protein / Q000032:analysis; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D009102:Multiple Organ Failure / Q000401:mortality; D011014:Pneumonia / Q000188:drug therapy* / Q000401:mortality* / Q000628:therapy; D011174:Portugal; D011446:Prospective Studies; D012121:Respiration, Artificial; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones; D002097:C-Reactive Protein