Effect of Corticosteroids on C-Reactive Protein in Patients with Severe Community-Acquired Pneumonia and High Inflammatory Response: The Effect of Lymphopenia
Por:
Torres, A, Ceccato, A, Ferrer, M, Gabarrus, A, Sibila, O, Cilloniz, C, Mendez, R, Menendez, R, Bermejo-Martin, J, Niederman, MS
Publicada:
1 sep 2019
Resumen:
Background: Lymphopenic patients with community-acquired pneumonia (CAP) have shown high mortality rates. Corticosteroids have immunomodulatory properties and regulate cytokine storm in CAP. However, it is not known whether their modulatory effect on cytokine secretion differs in lymphopenic and non-lymphopenic patients with CAP. Therefore, we aimed to test whether the presence of lymphopenia may modify the response to corticosteroids (mainly in C reactive protein (CRP)) in patients with severe CAP and high inflammatory status). Methods: A post hoc analysis of a randomized controlled trial (NCT00908713) which evaluated the effect of corticosteroids in patients with severe CAP and high inflammatory response (CRP > 15 mg/dL). Patients were clustered according to the presence of lymphopenia (lymphocyte count below 1000 cell/mm(3)). Results: At day 1, 35 patients (59%) in the placebo group presented with lymphopenia, compared to 44 patients (73%) in the corticosteroid group. The adjusted mean changes from day 1 showed an increase of 1.19 natural logarithm (ln) cell/mm(3) in the corticosteroid group and an increase of 0.67 ln cell/mm(3) in the placebo group (LS mean difference of the changes in ln (methylprednisolone minus placebo) 0.51, 95% CI (0.02 to 1.01), p = 0.043). A significant effect was also found for the interaction (p = 0.043) between corticosteroids and lymphopenia in CRP values at day 3, with lower values in patients without lymphopenia receiving corticosteroids after adjustments for potential confounders. Conclusion: In this exploratory post hoc analysis from ramdomized controlled trial (RCT) data, the response to corticosteroids, measured by CRP, may differ according to lymphocyte count. Further larger studies are needed to confirm this data.
Filiaciones:
Torres, A:
Univ Barcelona, IDIBAPS, Hosp Clin Barcelona, Dept Pneumol,Inst Clin Resp, Villarroel 170, E-08036 Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Resp, CB06-06-0028, Madrid 28029, Spain
Ceccato, A:
Univ Barcelona, IDIBAPS, Hosp Clin Barcelona, Dept Pneumol,Inst Clin Resp, Villarroel 170, E-08036 Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Resp, CB06-06-0028, Madrid 28029, Spain
Ferrer, M:
Univ Barcelona, IDIBAPS, Hosp Clin Barcelona, Dept Pneumol,Inst Clin Resp, Villarroel 170, E-08036 Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Resp, CB06-06-0028, Madrid 28029, Spain
Gabarrus, A:
Univ Barcelona, IDIBAPS, Hosp Clin Barcelona, Dept Pneumol,Inst Clin Resp, Villarroel 170, E-08036 Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Resp, CB06-06-0028, Madrid 28029, Spain
Sibila, O:
Hosp Santa Creu & Sant Pau, Servei Pneumol, St Antoni Maria Claret 167, Barcelona 08025, Spain
Cilloniz, C:
Univ Barcelona, IDIBAPS, Hosp Clin Barcelona, Dept Pneumol,Inst Clin Resp, Villarroel 170, E-08036 Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Resp, CB06-06-0028, Madrid 28029, Spain
Mendez, R:
IIS Hosp Univ & Politecn Fe, Serv Neumol, CIBERES, Avinguda de Fernando Abril Martorell 106, Valencia 46026, Spain
Univ Barcelona, PhD Program Med & Traslat Res, Gran Via Corts Catalanes 585, E-08007 Barcelona, Spain
Menendez, R:
Ctr Invest Biomed Red Enfermedades Resp, CB06-06-0028, Madrid 28029, Spain
IIS Hosp Univ & Politecn Fe, Serv Neumol, CIBERES, Avinguda de Fernando Abril Martorell 106, Valencia 46026, Spain
Bermejo-Martin, J:
Ctr Invest Biomed Red Enfermedades Resp, CB06-06-0028, Madrid 28029, Spain
Inst Invest BIomed Salamanca IBSAL, Grp Biomed Res Sepsis BioSepsis, Salamanca 37007, Spain
Niederman, MS:
Weill Cornell Med Coll, Div Pulm & Crit Care Med, New York, NY 10065 USA
Green Published, Green Submitted, gold
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