Hydrocortisone and Treatment of Multiple Trauma

To the Editor: In the randomized controlled trial by Dr Roquilly and colleagues,¹ the significantly lower proportion of multiple trauma patients who fulfilled study criteria for hospital-acquired pneumonia after receiving stress-dose hydrocortisone, as compared with placebo, could reflect a direct effect of this intervention on fever, aside from any effect on the underlying disease process. A pneumonia diagnosis required a patient to have at least 2 signs, including a body temperature greater than 38°C, an abnormally high or low leukocyte count, and purulent pulmonary secretions, plus certain x-ray and microbiological criteria. The antipyretic effect of corticosteroids would be expected to blunt the fever response to pulmonary inflammation. This would systematically bias the study toward patients in the corticosteroid group failing to meet the criteria for pneumonia even if pneumonia were present. It would be of interest to know what proportion of participants in each study group met the leukocyte count and pulmonary secretion criteria for pneumonia, apart from the fever criterion.