Individualizing Corticosteroid Use in Pneumonia

In this study, researchers propose a unique (individualized) approach to steroid treatment seeking to give the right dose of steroid to the right patient and at the right time. This study seeks to compare usual care to an individualized steroid dosing strategy by testing a marker of inflammation in the blood called C- reactive protein (CRP). The overall goal is to reduce an individual's exposure to steroids and the risk of potential side effects thereby increasing the potential benefit of using steroids to control inflammation in pneumonia.

Usual care as determined by the patient's primary team. Initiation and daily dosing of corticosteroid treatment will be based on clinicians' preference and clinicians.

Biomarker guided corticosteroid use. Initiation of corticosteroid will be recommended based on the an individual treatment rule (ITR) and subsequent dosing of corticosteroid will be recommended based on daily CRP values till CRP <50 mg/L.

Administered intravenously or orally based on daily CRP values and CRP corticosteriod dosing algorithm

Number of participants to require use of advanced respiratory support (high flow nasal cannula, non-invasive positive pressure ventilation and invasive ventilation)

Number of days without need for high flow nasal cannula, non-invasive positive pressure ventilation and invasive ventilation within 28 days of need for support. Assign 0 if death occurs with 28 days.

Inclusion Criteria: Hospitalized adult (≥ 18 years) patients. Community acquired pneumonia. Exclusion Criteria: Contraindications or unwillingness to use corticosteroids by patient or provider. History of adrenal insufficiency, septic shock, or another absolute indication for steroid use. Suspected pulmonary vasculitis or other autoimmune pulmonary disorder. Positive pregnancy test Comfort care.