Effect of corticosteroids on c-reactive protein in patients with severe community-acquired pneumonia and high inflammatory response : The effect of lymphopenia
Torres, Antoni (Centro de Investigación Biomedica En Red-Enfermedades Respiratorias)
Ceccato, Adrian (Centro de Investigación Biomedica En Red-Enfermedades Respiratorias)
Ferrer, Miquel (Centro de Investigación Biomedica En Red-Enfermedades Respiratorias)
Gabarrús, Albert (Centro de Investigación Biomedica En Red-Enfermedades Respiratorias)
Sibila, Oriol (Institut d'Investigació Biomèdica Sant Pau)
Cilloniz, Catia (Centro de Investigación Biomedica En Red-Enfermedades Respiratorias)
Méndez, Raúl (Universitat de Barcelona)
Menéndez Villanueva, Rosario (Instituto de Investigación Sanitaria La Fe de Valencia. Hospital Universitario y Politécnico La Fe. Servicio de Neumología. CIBERES)
Bermejo-Martin, Jesus F. (Instituto de Investigación BIomédica de Salamanca. Group For Biomedical Research in Sepsis (BioSepsis))
Niederman, Michael S. (Weill Cornell Medical College. Division of Pulmonary and Critical Care Medicine)

Date:	2019
Abstract:	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 [1] (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). 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 in the corticosteroid group and an increase of 0. 67 ln cell/mm 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.
Grants:	Instituto de Salud Carlos III PI19/00207
Note:	Altres ajuts: CIBERES; IDIBAPS; Grant PERIS 2016-2020 (Pla estratègic de recerca i innovació en salut); SEPAR 2018 grant.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Pneumonia ; Corticosteroids ; Inflammatory response
Published in:	Journal of clinical medicine, Vol. 8 Núm. 9 (september 2019) , p. 1461, ISSN 2077-0383

DOI: 10.3390/jcm8091461
PMID: 31540339

6 p, 443.0 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
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