Clinical Stability and Biomarkers in Community-Acquired Pneumonia.

Menéndez, Rosário; Reyes, Soledad; Martínez, Raquel; Esquinas, Cristina; Piñer, Raquel; Martinez, A.; Mensa, José; Filella, X; Torres, Antoni

doi:10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a1714

Cited by 4 publications

(4 citation statements)

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“…It was shown that there is a direct correlation between CAP's severity and the levels of circulating inflammatory cytokines in CAP patients [6][7][8]10]. One of the main factors controlling the progression of pneumonia is the host inflammatory response, which increases excessively in non-responding pneumonia [11,12].…”

Section: Introductionmentioning

confidence: 99%

Corticosteroids and ICU Course of Community Acquired Pneumonia in Egyptian Settings

Sabry¹,

Omar²

2011

113

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Background: Pneumonia is the most common cause of community-acquired infection requiring ICU admission. 60-87% of patients with severe community acquired pneumonia (CAP) admitted to the ICU develops respiratory failure and require mechanical ventilation (MV). Objectives: To assess the efficacy and safety of adjunctive low dose hydrocortisone infusion treatment in Egyptian ICU patients with CAP. Methods: Hospitalized patients, clinically and radiologically diagnosed with CAP, were randomized to receive hydrocortisone 12.5 mg/h IV infusion for 7 days or placebo, along with antibiotics. The end-points of the study were improvement in PaO2:FIO2 (PaO2:FIO2 > 300 or ≥100 increase from study entry) and SOFA score by study day 8 and the development of delayed septic shock. Results: 80 patients were recruited, 40 of them received hydrocortisone and the remaining 40 received placebo. By study day 8, hydrocortisone treated patients showed a significant improvement in PaO2:FIO2 and chest radiograph score, and a significant reduction in C-reactive protein (CRP) levels, Sepsis-related Organ Failure Assessment (SOFA) score, and delayed septic shock compared to the control group. Hydrocortisone treatment was associated with a significant reduction in the duration of MV. However, hydrocortisone infusion did not show significant difference in the ICU mortality. Conclusions: adjunctive 7-day course of low dose hydrocortisone IV in patients with CAP hastens recovery of pneumonia and prevents the development of sepsis related complications with a significant reduction in duration of the mechanical ventilation

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Section: Introductionmentioning

confidence: 99%

Corticosteroids and ICU Course of Community Acquired Pneumonia in Egyptian Settings

Sabry¹,

Omar²

2011

113

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“…One of the key factors determining the progression of pneumonia is the host inflammatory response, which seems to be increased excessively in nonresponding severe pneumonia [4,5]. The purpose of the present article is to review the evidence in the literature supporting a beneficial role of glucocorticosteroids (GCs) as an adjuvant treatment in severe pneumonia.…”

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confidence: 99%

Corticosteroids in severe pneumonia

Sibila¹,

Agustı́²,

Torres³

2008

European Respiratory Journal

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The mortality rate in severe community-or hospital-acquired pneumonia is very high, ranging 20-50%. Despite advances in antimicrobial therapy and supportive measures, this rate has not changed in recent years, suggesting that other factors are also responsible for the poor outcome. An abnormal increase in the local and systemic inflammatory response is associated with poor outcome, and this occurs despite adequate antibiotic therapy.There is evidence that acute administration of corticosteroids decreases the inflammatory response and might decrease mortality in severe pneumonia. This has been shown in one small randomised controlled study, terminated prematurely due to 0% mortality in the intervention arm. In addition, an experimental study showed that glucocorticosteroids decrease lung inflammatory response and lung bacterial burden, confirming the results obtained through in vitro investigations.Although these results are promising and suggest a novel role of glucocorticosteroids in pneumonia, the inherent risks and potential side-effects of these drugs require further controlled clinical trials in order to better define the target population before their general use in clinical practice. Specifically, dosage, period of administration, titration, tapering and side-effects are some of the key questions that need to be investigated.

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“…66 81 82 When CS is accompanied by a controlled inflammatory response, as measured by biomarkers, the risk of serious complications is very low. 83 Indeed, CS or clinical cure is widely used in the design of randomized clinical trials and other studies in CAP. 84 85 86 Clinical stability is probably the cornerstone for antimicrobial stewardship in CAP along with a concordant-guidelines antibiotic scheme.…”

Section: Clinical Stabilitymentioning

confidence: 99%