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, Gianfranco Meduri

Research output: Contribution to journalArticle

446 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:FlO2 (PaO2:FlO2 > 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:FlO2, 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 PaO2-FlO2 (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 (US)
Pages (from-to)242-248
Number of pages7
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume171
Issue number3
DOIs
StatePublished - Feb 1 2005

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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

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care 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, Gianfranco.

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, G 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, Gianfranco. / 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.
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