Hydrocortisone infusion for severe community-acquired pneumonia: A preliminary randomized study

Marco Confalonieri, Rosario Urbino, Alfredo Potena, Marco Piattella, Piercarlo Parigi, Giacomo Puccio, Rossana Della Porta, Carbone Giorgio, Francesco Blasi, Reba Umberger, G. Umberto Meduri

Research output: Contribution to journalArticle

Abstract

We hypothesize that hydrocortisone infusion in severe community-acquired pneumonia attenuates systemic inflammation and leads to earlier resolution of pneumonia and a reduction in sepsis-related complications. In a multicenter trial, patients admitted to the Intensive Care Unit (ICU) with severe community-acquired pneumonia received protocol-guided antibiotic treatment and were randomly assigned to hydrocortisone infusion or placebo. Hydrocortisone was given as an intravenous 200-mg bolus followed by infusion at a rate of 10 mg/hour for 7 days. Primary end-points of the study were improvement in Pa O2:Fl O2 (Pa O2:Fl O2 > 300 or ≥ 100 increase from study entry) and multiple organ dysfunction syndrome (MODS) score by Study Day 8 and reduction in delayed septic shock. Forty-six patients entered the study. At study entry, the hydrocortisone group had lower Pa O2:Fl O2, and higher chest radiograph score and C-reactive protein level. By Study Day 8, treated patients had, compared with control subjects, a significant improvement in Pa O2-Fl O2 (P = 0.002) and chest radiograph score (p <0.0001), and a significant reduction in C-reactive protein levels (p = 0.01), MODS score (p = 0.003), and delayed septic shock (p = 0.001). Hydrocortisone treatment was associated with a significant reduction in length of hospital stay (p = 0.03) and mortality (p = 0.009).

Original languageEnglish
Pages (from-to)242-248
Number of pages7
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume171
Issue number3
DOIs
Publication statusPublished - Feb 1 2005

Keywords

  • C-reactive protein
  • Community-acquired pneumonia
  • Hydrocortisone
  • Respiratory failure
  • Severe sepsis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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    Confalonieri, M., Urbino, R., Potena, A., Piattella, M., Parigi, P., Puccio, G., Della Porta, R., Giorgio, C., Blasi, F., Umberger, R., & Meduri, G. U. (2005). Hydrocortisone infusion for severe community-acquired pneumonia: A preliminary randomized study. American Journal of Respiratory and Critical Care Medicine, 171(3), 242-248. https://doi.org/10.1164/rccm.200406-808OC