Is prolonged low-dose glucocorticoid treatment beneficial in community-acquired pneumonia?

Marco Confalonieri, Djillali Annane, Caterina Antonaglia, Mario Santagiuliana, Ediva M. Borriello, Gianfranco Meduri

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Community-acquired pneumonia (CAP) has a significant impact on public health in terms of short-term and long-term morbidity and mortality. Irrespective of microbiological etiology, the host's inability to fully downregulate systemic inflammation is the dominant pathogenetic process contributing to acute and long-term morbidity and mortality in CAP. Glucocorticoids are the natural regulators of inflammation, and their production increases during infection. There is consistent evidence that downregulation of systemic inflammation with prolonged low-dose glucocorticoid treatment in patients with severe sepsis and acute respiratory distress syndrome improves cardiovascular and pulmonary organ physiology. A recent meta-analysis of pooled controlled small trials (n = 970) of patients admitted with CAP found improved short-term mortality in the subgroup with severe CAP and/or receiving >5 days of glucocorticoid treatment. We have expanded on this meta-analysis by including patients with CAP recruited in trials investigating prolonged low-dose glucocorticoid treatment in septic shock and/or early acute respiratory distress syndrome (n = 1,206). Our findings confirm a survival advantage for severe CAP (RR 0.66, 95% confidence interval 0.51-0.84; p =.001). A large randomized trial is in progress to confirm the aggregate findings of these small trials and to evaluate the long-term effect of this low-cost treatment.

Original languageEnglish (US)
Pages (from-to)158-166
Number of pages9
JournalCurrent Infectious Disease Reports
Volume15
Issue number2
DOIs
StatePublished - Apr 1 2013

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Glucocorticoids
Pneumonia
Adult Respiratory Distress Syndrome
Inflammation
Meta-Analysis
Mortality
Therapeutics
Down-Regulation
Morbidity
Septic Shock
Health Care Costs
Sepsis
Public Health
Confidence Intervals
Lung
Survival
Infection

All Science Journal Classification (ASJC) codes

  • Infectious Diseases

Cite this

Is prolonged low-dose glucocorticoid treatment beneficial in community-acquired pneumonia? / Confalonieri, Marco; Annane, Djillali; Antonaglia, Caterina; Santagiuliana, Mario; Borriello, Ediva M.; Meduri, Gianfranco.

In: Current Infectious Disease Reports, Vol. 15, No. 2, 01.04.2013, p. 158-166.

Research output: Contribution to journalArticle

Confalonieri, Marco ; Annane, Djillali ; Antonaglia, Caterina ; Santagiuliana, Mario ; Borriello, Ediva M. ; Meduri, Gianfranco. / Is prolonged low-dose glucocorticoid treatment beneficial in community-acquired pneumonia?. In: Current Infectious Disease Reports. 2013 ; Vol. 15, No. 2. pp. 158-166.
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