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Article Dans Une Revue New England Journal of Medicine Année : 2023

Hydrocortisone in Severe Community-Acquired Pneumonia

Hydrocortisone dans la pneumonie sévère acquise dans la communauté

1 UT - Université de Tours
2 CIC - Centre d’Investigation Clinique [Tours] CIC 1415
3 CEPR - Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100
4 NanoRegMed - Nanomédecine Régénérative
5 LIPNESS - Equipe LIPNESS (LNC - U1231)
6 CIC-EC - Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques
7 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
8 UB - Université de Bourgogne
9 HLSO - Hôpital La Source [Orléans]
10 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution
11 HNFC - Hôpital Nord Franche-Comté [Hôpital de Trévenans]
12 Hôtel-Dieu de Nantes
13 2I - Infection et inflammation
14 Hôpital Raymond Poincaré (Garches) [GHU AP-HP Université Paris-Saclay]
15 Centre Hospitalier Victor Dupouy
16 LMGE - Laboratoire Microorganismes : Génome et Environnement
17 CRSA - Centre de Recherche Saint-Antoine
18 CHD Vendée - Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon
19 CIC 1402 - CIC Poitiers – Centre d'investigation clinique de Poitiers
20 Hôpital Cochin [AP-HP]
21 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
22 Centre hospitalier Saint-Brieuc
23 RESINFIT - Anti-infectieux : supports moléculaires des résistances et innovations thérapeutiques
24 CIC1435 - Centre d'Investigation Clinique de Limoges
25 Service de Réanimation Polyvalente [CHU Limoges]
26 CHR de Metz-Thionville
27 UL - Université de Lorraine
28 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
29 Centre Hospitalier Le Mans (CH Le Mans)
30 Hôpital d'Instruction des Armées Clermont Tonnerre
31 APHM - Assistance Publique - Hôpitaux de Marseille
32 AMU - Aix Marseille Université
33 CH Montauban - Centre hospitalier de Montauban
34 LaTIM - Laboratoire de Traitement de l'Information Medicale
35 CHU - BREST - Hôpital de la Cavale Blanche - CHRU Brest
36 Hôpital Robert Ballanger [Aulnay-sous-Bois]
37 Hôpital de Hautepierre [Strasbourg]
38 Centre Hospitalier de Bourg en Bresse
39 Service de réanimation médicale [CHU Caen]
40 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
41 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
42 CH de Saint-Malo [Broussais]
43 RTD - Recherche translationnelle sur le diabète - U 1190
44 Université de Lille
45 Hôpital Roger Salengro [Lille]
46 SPHERE - MethodS in Patients-centered outcomes and HEalth ResEarch
Jean Reignier
Guillaume Louis
Marie Leclerc
  • Fonction : Auteur
Carine Coffre
  • Fonction : Auteur
Hélène Bourgoin
  • Fonction : Auteur
Céline Lengellé
  • Fonction : Auteur
Amélie Le Gouge
  • Fonction : Auteur

Résumé

Background Whether the antiinflammatory and immunomodulatory effects of glucocorticoids may decrease mortality among patients with severe community-acquired pneumonia is unclear. Methods In 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 7 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. Results A 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. Conclusions Among 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, NCT02517489. opens in new tab.)
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Dates et versions

hal-04179377 , version 1 (09-08-2023)

Identifiants

Citer

Pierre-François Dequin, Ferhat Meziani, Jean-Pierre Quenot, Toufik Kamel, Jean-Damien Ricard, et al.. Hydrocortisone in Severe Community-Acquired Pneumonia. New England Journal of Medicine, 2023, 388 (21), pp.1931-1941. ⟨10.1056/NEJMoa2215145⟩. ⟨hal-04179377⟩
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