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 language | English |
|---|---|
| Pages (from-to) | 242-248 |
| Number of pages | 7 |
| Journal | American Journal of Respiratory and Critical Care Medicine |
| Volume | 171 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Feb 1 2005 |
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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 journal › Article
}
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 -