Corticosteroids in Community Acquired Pneumonia

Exclusion Criteria

• •1. Systemic steroid use within the past 30-days.
• •2. Clinical team planning to treat with systemic steroids during this hospitalization independent of the study protocol.
• •3. Unable to randomize patient within 24 hours of hospital presentation.
• •4. Hospital-acquired pneumonia, defined as development of clinical and radiographic signs of pneumonia as an inpatient in an acute care hospital. (Residence in a nursing home or assisted living facility is not an exclusion criterion.)
• •5. Unable to follow simple commands or non-verbal prior to this acute illness.
• •6. Pre-existing severe dementia, defined as an Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) score ≥ 4.12.
• •7. Concomitant acute decompensated heart failure requiring intravenous diuretics
• •8. Serum sodium \> 145 mEq/L (hypernatremia) or potassium \< 3.5 mEq/L (hypokalemia) at screening and randomization
• •9. Systolic blood pressure \> 180 mmHg or a diastolic blood pressure \> 100 mmHg at the start and end of screening.
• •10. Any history of diabetes mellitus, having a serum blood glucose \> 250 mg/dL, or requiring an anti-diabetic medication (e.g., insulin)
• •11. Previous allergic or adverse reaction to a corticosteroid
• •12. Severe immunosuppression, defined as any of the following: HIV with CD4 count \< 200 cells/mm3, absolute neutrophil count \< 500 cells/mm3, solid organ or hematopoietic stem cell transplant with in the past 90 days.
• •13. Cystic fibrosis
• •14. Active cancer, defined as new diagnosis or treatment for cancer in the past 6 months.
• •15. Any history of adrenal insufficiency
• •16. Substance abuse (alcohol, opioid, benzodiazepines, methamphetamines, cocaine) within the past year
• •17. Any history of hospitalizations due to psychiatric illnesses within the past year
• •18. Gastro-intestinal bleeding treated with hospital admission and/or blood transfusion within the past 3 months.
• •19. Pre-existing medical condition resulting in a life expectancy \< 6 months.
• •20. Clinical team does not believe the patient should enter the study due to concerns about potential steroid-related complications.