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Randomised controlled trial
Management of patients hospitalised with community-acquired pneumonia: dexamethasone reduces length of stay by 1 day
  1. G Umberto Meduri1,
  2. Marco Confalonieri2
  1. 1Department of Medicine, Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis, Tennessee, USA
  2. 2Pneumology Department, University Hospital of Trieste, Trieste, Italy
  1. Correspondence to G Umberto Meduri
    Department of Medicine, Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center, 1030 Jefferson Avenue, Suite room #CW444, Memphis, TN 38104, USA; gmeduri{at}uthsc.edu

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Context

Pneumonia develops when pathogens invading the sterile lower respiratory tract activate the innate immune response to generate local and systemic inflammation.1 The host's inability to fully downregulate systemic inflammation is the dominant pathogenetic process contributing to acute and long-term morbidity and mortality. In the last decade, we have recognised that, for pneumonia, (1) acute mortality has not improved since the introduction of antibiotics, (2) the heart is a major target organ with more cardiovascular events (particularly for those with atherosclerosis), (3) biological resolution lags weeks behind clinical resolution and (4) most patients discharged from the hospital have subclinical low-grade systemic inflammation and substantial excess mortality for years.1 On the basis of 1-year mortality, pneumonia is the third leading cause of death in the …

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