A Pragmatic Trial of Glucocorticoids for Community-Acquired Pneumonia.

Whether these drugs are beneficial in low-resource settings with limited diagnostic and treatment facilities is unclear.

在资源有限、诊断和治疗设施有限的环境中，这些药物是否有益尚不清楚。

Methods

In this pragmatic, open-label, randomized, controlled trial conducted in 18 public hospitals in Kenya, we assigned adult patients who had received a diagnosis of CAP and who did not have a clear indication for glucocorticoids to receive either standard care for CAP or oral low-dose glucocorticoids for 10 days in addition to standard care.

在这项在肯尼亚18家公立医院进行的实用、开放标签、随机对照试验中，我们分配了已经确诊为社区获得性肺炎（CAP）且没有明确使用糖皮质激素指征的成年患者，接受标准的CAP护理或在标准护理基础上加用口服低剂量糖皮质激素10天。

The primary outcome was death from any cause at 30 days after enrollment.

主要结果是入组后30天内的全因死亡。

Results

A total of 2180 patients underwent randomization (1089 assigned to the glucocorticoid group and 1091 to the standard-care group).

共有2180名患者进行了随机分组（1089名被分配到糖皮质激素组，1091名被分配到标准护理组）。

The median age of the patients was 53 years (interquartile range, 38 to 72); 46% were women.

患者的中位年龄为53岁（四分位数间距，38至72岁）；46%为女性。

At day 30, deaths were reported in 530 patients (24.3%): 246 patients (22.6%) in the glucocorticoid group and 284 patients (26.0%) in the standard-care group (hazard ratio, 0.84; 95% confidence interval, 0.73 to 0.97; P = 0.02).

在第30天，报告了530名患者（24.3%）死亡：糖皮质激素组246名患者（22.6%）和标准护理组284名患者（26.0%）（风险比，0.84；95%置信区间，0.73至0.97；P = 0.02）。

The frequencies of adverse events and serious adverse events were similar in the two trial groups.

两组试验中的不良事件和严重不良事件的发生频率相似。

Serious adverse events that were considered to be related to glucocorticoid administration occurred in 5 patients (0.5%).

被认为与糖皮质激素给药相关的严重不良事件发生在5名患者中（0.5%）。

Conclusions

In patients with CAP in a low-resource setting, adjunctive glucocorticoid therapy was associated with a lower risk of death than standard care.

在低资源环境中的社区获得性肺炎患者中，辅助性糖皮质激素治疗与标准治疗相比，死亡风险较低。

(Funded by Wellcome Trust and others; SONIA PACTR number, PACTR202111481740832; ISRCTN number, ISRCTN36138594.).

(由Wellcome Trust和其他机构资助；SONIA PACTR编号，PACTR202111481740832；ISRCTN编号，ISRCTN36138594。)