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(O(2)):FI(O(2)) (Pa(O(2)):FI(O(2)) > 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(O(2)):FI(O(2)), 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(O(2)):FI(O(2)) (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).

• Authors: Marco Confalonieri, Rosario Urbino, Alfredo Potena, Marco Piattella, Piercarlo Parigi, Giacomo Puccio, Rossana Della Porta, Carbone Giorgio, Francesco Blasi, Reba Umberger, G Umberto Meduri
• Journal: American journal of respiratory and critical care medicine (Am J Respir Crit Care Med) Vol. 171 Issue 3 Pg. 242-8 (Feb 01 2005) ISSN: 1073-449X [Print] United States
• PMID: 15557131 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Anti-Inflammatory Agents
• Placebos
• C-Reactive Protein
• Oxygen
• Hydrocortisone

Topics

• Aged
• Anti-Bacterial Agents (therapeutic use)
• Anti-Inflammatory Agents (administration & dosage, therapeutic use)
• C-Reactive Protein (analysis)
• Community-Acquired Infections (drug therapy)
• Double-Blind Method
• Female
• Follow-Up Studies
• Hospitalization
• Humans
• Hydrocortisone (administration & dosage, therapeutic use)
• Infusions, Intravenous
• Length of Stay
• Male
• Middle Aged
• Multiple Organ Failure (classification)
• Oxygen (blood)
• Placebos
• Pneumonia (drug therapy)
• Radiography, Thoracic
• Shock, Septic (classification)
• Survival Rate