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Published ahead of print on November 19, 2004, doi:10.1164/rccm.200406-808OC
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American Journal of Respiratory and Critical Care Medicine Vol 171. pp. 242-248, (2005)
© 2005 American Thoracic Society
doi: 10.1164/rccm.200406-808OC

Original Article

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 and G. Umberto Meduri

Ospedale di Trieste, Trieste; Ospedale Gradenigo-Torino; Ospedale Molinette di Torino; Arcispedale S. Anna di Ferrara; Ospedale di Crema; Ospedale di Paderno Dugnano-Milano; Institute of Respiratory Diseases, University of Milan, Milan, Italy; and Memphis Lung Research Program, Memphis, Tennessee

Correspondence and requests for reprints should be addressed to Dr. Marco Confalonieri, Azienda Ospedaliero-Universitaria di Trieste, Strada di Fiume 447, 34100 Trieste, Italy. E-mail: marco.confalonieri{at}aots.sanita.fvg.it

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 PaO2:FIO2 (PaO2:FIO2 > 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 PaO2:FIO2, 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:FIO2 (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).

Key Words: community-acquired pneumonia • C-reactive protein • hydrocortisone • respiratory failure • severe sepsis




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