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Published ahead of print on November 19, 2004, doi:10.1164/rccm.200406-808OC

Am. J. Respir. Crit. Care Med., Volume 171, Number 3, February 2005, 242-248

A more recent version of this article appeared on February 1, 2005
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Submitted on June 24, 2004
Accepted on October 31, 2004

Hydrocortisone Infusion for Severe Community-Acquired Pneumonia: a Preliminary Randomized Study

Marco Confalonieri1*, Rosario Urbino2, Alfredo Potena3, Marco Piattella3, Piercarlo Parigi4, Giacomo Puccio5, Rossana Della Porta1, Giorgio Carbone6, Francesco Blasi7, Reba Umberger8, and G. Umberto Meduri8

1 Respiratory Intensive Care Unit, Cattinara Hospital, Trieste, Italy, 2 Emergency Department, Hospital Molinette, Turin, Italy, 3 Respiratory Intensive Care Unit, Arcispedale S. Anna, Ferrara, Italy, 4 Respiratory Intensive Care Unit, General Hospital, Crema, Italy, 5 Intensive Care Unit, Hospital of Paderno Dugnano, Milan, Italy, 6 Emergency Department, Gradenigo Hospital, Turin, Italy, 7 Institute of Respiratory Diseases, University of Milan, Milan, Italy, 8 Memphis Lung Research Program, University of Tennessee, Memphis, TN, USA

* To whom correspondence should be addressed. 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/h 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 (CRP) level. By study day 8, treated patients had, in comparison to control, a significant improvement in PaO2:FiO2 (P = 0.002) and chest radiograph score (P < 0.0001) and a significant reduction in CRP 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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