Please use this identifier to cite or link to this item: http://hdl.handle.net/2445/145137
Title: Effect of Corticosteroids on C-Reactive Protein in Patients with Severe Community-Acquired Pneumonia and High Inflammatory Response: The Effect of Lymphopenia
Author: Torres Martí, Antoni
Ceccato, Adrian
Ferrer Monreal, Miquel
Gabarrús, Albert
Sibila Vidal, Oriol
Cillóniz, Catia
Menéndez, Rosario
Bermejo Martín, Jesús
Niederman, Michael S.
Keywords: Pneumònia adquirida a la comunitat
Corticosteroides
Community-acquired pneumonia
Adrenocortical hormones
Issue Date: 13-Sep-2019
Publisher: MDPI
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 (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/mm3 ). 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/mm3 in the corticosteroid group and an increase of 0.67 ln cell/mm3 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.
Note: Reproducció del document publicat a: https://doi.org/10.3390/jcm8091461
It is part of: Journal of Clinical Medicine, 2019, vol. 8, num. 9, p. 1461
URI: http://hdl.handle.net/2445/145137
Related resource: https://doi.org/10.3390/jcm8091461
ISSN: 2077-0383
Appears in Collections:Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)
Articles publicats en revistes (Medicina)

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