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

459 Citations (Scopus)

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

Fingerprint

Hydrocortisone
Pneumonia
Organ Dysfunction Scores
Multiple Organ Failure
Septic Shock
C-Reactive Protein
Length of Stay
Thorax
Multicenter Studies
Intensive Care Units
Sepsis
Placebos
Anti-Bacterial Agents
Inflammation
Mortality
Therapeutics

Keywords

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

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Hydrocortisone infusion for severe community-acquired pneumonia : A preliminary randomized study. / Confalonieri, Marco; Urbino, Rosario; Potena, Alfredo; Piattella, Marco; Parigi, Piercarlo; Puccio, Giacomo; Della Porta, Rossana; Giorgio, Carbone; Blasi, Francesco; Umberger, Reba; Meduri, G. Umberto.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 171, No. 3, 01.02.2005, p. 242-248.

Research output: Contribution to journalArticle

Confalonieri, M, Urbino, R, Potena, A, Piattella, M, Parigi, P, Puccio, G, Della Porta, R, Giorgio, C, Blasi, F, Umberger, R & Meduri, GU 2005, 'Hydrocortisone infusion for severe community-acquired pneumonia: A preliminary randomized study', American Journal of Respiratory and Critical Care Medicine, vol. 171, no. 3, pp. 242-248. https://doi.org/10.1164/rccm.200406-808OC
Confalonieri, Marco ; Urbino, Rosario ; Potena, Alfredo ; Piattella, Marco ; Parigi, Piercarlo ; Puccio, Giacomo ; Della Porta, Rossana ; Giorgio, Carbone ; Blasi, Francesco ; Umberger, Reba ; Meduri, G. Umberto. / Hydrocortisone infusion for severe community-acquired pneumonia : A preliminary randomized study. In: American Journal of Respiratory and Critical Care Medicine. 2005 ; Vol. 171, No. 3. pp. 242-248.
@article{069252a3ce614bc98f4168356227ffb0,
title = "Hydrocortisone infusion for severe community-acquired pneumonia: A preliminary randomized study",
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).",
keywords = "C-reactive protein, Community-acquired pneumonia, Hydrocortisone, Respiratory failure, Severe sepsis",
author = "Marco Confalonieri and Rosario Urbino and Alfredo Potena and Marco Piattella and Piercarlo Parigi and Giacomo Puccio and {Della Porta}, Rossana and Carbone Giorgio and Francesco Blasi and Reba Umberger and Meduri, {G. Umberto}",
year = "2005",
month = "2",
day = "1",
doi = "10.1164/rccm.200406-808OC",
language = "English",
volume = "171",
pages = "242--248",
journal = "American Journal of Respiratory and Critical Care Medicine",
issn = "1073-449X",
publisher = "American Thoracic Society - AJRCCM",
number = "3",

}

TY - JOUR

T1 - Hydrocortisone infusion for severe community-acquired pneumonia

T2 - A preliminary randomized study

AU - Confalonieri, Marco

AU - Urbino, Rosario

AU - Potena, Alfredo

AU - Piattella, Marco

AU - Parigi, Piercarlo

AU - Puccio, Giacomo

AU - Della Porta, Rossana

AU - Giorgio, Carbone

AU - Blasi, Francesco

AU - Umberger, Reba

AU - Meduri, G. Umberto

PY - 2005/2/1

Y1 - 2005/2/1

N2 - 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).

AB - 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).

KW - C-reactive protein

KW - Community-acquired pneumonia

KW - Hydrocortisone

KW - Respiratory failure

KW - Severe sepsis

UR - http://www.scopus.com/inward/record.url?scp=19944430688&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=19944430688&partnerID=8YFLogxK

U2 - 10.1164/rccm.200406-808OC

DO - 10.1164/rccm.200406-808OC

M3 - Article

C2 - 15557131

AN - SCOPUS:19944430688

VL - 171

SP - 242

EP - 248

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

SN - 1073-449X

IS - 3

ER -