الفهرس 
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Abstract
Community acquired pneumonia (CAP) is defined as infection of the lung parenchyma in a person who is not hospitalized or living in a long-term care facility for ≥ 2 weeks. CAP is one of the most common serious infections in children.
The major cause and precursor of sepsis and critical illness is respiratory tract infections. Community-acquired pneumonia (CAP) is the major infection-related cause of death in developed countries.
High cortisol levels reflect a higher degree of stress.The effects of cortisol are directed toward the acute provision of energy, protection against excessive inflammation, and improvement in hemodynamic status.
Hence, the aim of this study was to evaluate the cortisol levels in the serum of children suffering from CAP with age group range from 1 month to 12 years, we aimed to study the correlation between serum cortisol levels and severity, outcome of CAP.
Our study was carried out on 80 child; 49 (61.2%) males and 31 (38.8%) females obtained from outpatient clinic or admitted in pediatric department of El-Minia university hospital. They divided into 4 groups including 13 patients group Ia with mild pneumonia, 21 patients group Ib with severe pneumonia and 16 patients group Ic with very severe pneumonia plus 30 apparantly healthy children was taken as a control group II.
All children were subjected to full history taking (age, sex, SES, cough, fever, dyspnea, dietetic history, other symptoms) and examination (consciousness level, HR, RR, temperature, complexion, heart and abdominal examination, local chest examination including inspection, palpation, percussion and auscultation) investigations (CXR, CBC, CRP, ESR, ABG, serum cortisol level).
Statistical analysis of the results revealed the following
We found in our study that there was a highly statistically significant increase in serum cortisol levels in patients group I (28.73 ± 5.95 µg/dl) when compared with control group II (9.63 ± 3.73 µg/dl).
We found also in our study that there was a highly statistically significant increase in serum cortisol levels in patients group Ic (35.86 ± 4.42 µg/dl) when compared with patient group Ib (27.33 ± 1.21 µg/dl) and group Ia (22.21 ± 0.84 µg/dl) and a statistically significant increase in serum cortisol levels in patient group Ib when compared with group Ia.
We found also in our study that there was a statistically significant increase in cortisol levels in non survivors (41.32 ± 1.05 µg/dl) when compared with survivors (27.63 ± 4.82 µg/dl) .
We found also in our study that there was a statistically significant strong correlation between cortisol level and severity grading of pneumonia (r = 0.927 , P = <0.001).