Impact of systemic corticosteroids on the clinical course and outcomes of patients with severe community-acquired pneumonia: a cohort study |
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Authors: | Salluh Jorge I F Soares Márcio Coelho Luis M Bozza Fernando A Verdeal Juan Carlos R Castro-Faria-Neto Hugo C e Silva José Roberto Lapa Bozza Patrícia T Póvoa Pedro |
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Affiliation: | a Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazilb Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, 20230-130, CEDOC, Faculty of Medical Sciences, New University of Lisbon, Lisboa, Portugalc Instituto de Pesquisa Clínica Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazild Intensive Care Unit, Hospital Barra D''Or, Rio de Janeiro, Brazile Laboratory of Immunopharmacology, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazilf Pulmonary Diseases Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil |
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Abstract: | IntroductionOur aim was to evaluate the impact of corticosteroids on clinical course and outcomes of patients with severe community-acquired pneumonia (CAP) requiring invasive mechanical ventilation.MethodsThis was a cohort study of patients with severe CAP from 2 intensive care units in tertiary hospitals in Brazil and Portugal.ResultsA total of 111 patients were included (median age, 69 years; 56% men; 34% hospital mortality). Corticosteroids were prescribed in 61 (55%) patients. Main indications for their use were bronchospasm (52.5%) and septic shock (36%). Mortality rate of patients treated with and without corticosteroids was comparable (29.5% vs 32%, P = .837). No significant differences were observed on clinical course from day 1 to day 7 as assessed by the Sequential Organ Failure Assessment score (P = .95). Furthermore, C-reactive protein declined similarly in both groups (P = .147). In a multivariate analysis, mortality was associated with older age and higher Acute Physiology and Chronic Health Evaluation II score.ConclusionsIn patients with severe CAP requiring invasive mechanical ventilation, adjunctive therapy with corticosteroids did not influence intensive care unit and hospital mortality. In addition, no changes were observed on weaning from vasopressors, on recovery from organ failure/dysfunction as assessed by the Sequential Organ Failure Assessment score, as well as on C-reactive protein course. |
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Keywords: | Community-acquired pneumonia Corticosteroids C-reactive protein Mechanical ventilation Multiple organ failure Severe sepsis |
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