Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study.
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).
Confalonieri
Marco
M
Azienda Ospedaliero-Universitaria di Trieste, Strada di Fiume 447, 34100 Trieste, Italy. marco.confalonieri@aots.sanita.fvg.it
Urbino
Rosario
R
Potena
Alfredo
A
Piattella
Marco
M
Parigi
Piercarlo
P
Puccio
Giacomo
G
Della Porta
Rossana
R
Giorgio
Carbone
C
Blasi
Francesco
F
Umberger
Reba
R
Meduri
G Umberto
GU
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000032:analysis; D017714:Community-Acquired Infections / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000145:classification; D010100:Oxygen / Q000097:blood; D010919:Placebos; D011014:Pneumonia / Q000188:drug therapy*; D013902:Radiography, Thoracic; D012772:Shock, Septic / Q000145:classification; D015996:Survival Rate
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D010919:Placebos; D002097:C-Reactive Protein; D010100:Oxygen; D006854:Hydrocortisone