Chest
Clinical InvestigationHydrocortisone and Tumor Necrosis Factor in Severe Community-Acquired Pneumonia: A Randomized Controlled Study
Section snippets
Methods
This study was conducted in the ICU of a tertiary care teaching hospital. The study was approved hv the Institutional Review Board for research involving human subjects. Informed consent was obtained from all patients.
Patients with community-acquired pneumonia admitted to the medical admissions ward with three or more of the following criteria (British Thoracic Society criteria of severe pneumonia) were identified and admitted to the ICU prior to the commencement of antibiotic therapy:4 (1)
Results
Thirty patients were entered into the study: 16 received placebo and 14 received hydrocortisone. The admission characteristics of the two groups are listed in Table 1. The patients who received placebo tended to be sicker than the hydrocortisone group; however, only the WBC count was significantly different between the two groups.
Serum TNF-α levels were elevated in all the patients studied. The serial TNF levels are listed in Table 2. There was no difference in the TNF-α levels between the
Discussion
In this study, we have documented that patients with severe community-acquired pneumonia have high baseline levels of serum TNF-α that are unaffected by bactericidal antibiotics and remain stable when followed for up to 12 h. Furthermore, the serum TNF-α levels were unaffected by treatment with low-dose hydrocortisone. In addition, we were unable to demonstrate a relationship between the serum TNF-α level and illness severity as measured by the APACHE II score, lung injury score, or patient
Conclusion
The use of bactericidal antibiotics in patients with severe pneumonia was not associated with an increase in serum TNF-α levels. Furthermore, hydrocortisone given at the time of commencing antibiotic treatment had no effect on the serum TNF-α levels or the clinical course of patients with severe community-acquired pneumonia.
ACKNOWLEDGMENT
The authors acknowledge the technical assistance of Avril Mer, Dip, Medical Tech.
References (37)
Community-acquired pneumonia
Br J Dis Chest
(1987)- et al.
Association between tumor necrosis factor in the serum and fatal outcome in patients with meningococcal disease
Lancet
(1987) Production and clearance of tumor necrosis factor in rats exposed to endotoxin and dexamethasone
Clin Immunol Immunopathol
(1987)- et al.
Early methylprednisolone treatment for septic syndrome and adult respiratory distress syndrome
Chest
(1987) - et al.
Pneumococcal bacteremia with special reference to bacteremic pneumococcal pneumonia
Ann Intern Med
(1964) - et al.
Invasive pneumococcal infections: incidence, predisposing factors and prognosis
Rev Infect Dis
(1985) Community-acquired pneumonia in adults in British Hospitals in 1982-1983: a survey of aetiology, mortality, prognostic factors and outcome
Q J Med
(1987)- et al.
Failure of intensive care unit support to influence mortality from pneumococcal bacteremia
JAMA
(1983) - et al.
Community acquired pneumonia of diverse etiology: prognostic features in patients admitted to an intensive care unit and a ‘severity of illness’ score
Int Care Med
(1989) Pneumococcal resistance to antibiotics
Clin Microbiol Rev
(1990)
Dexamethasone therapy for bacterial meningitis: results of two double-blind, placebo controlled trials
N Engl J Med
Magnetic resonance imaging and dexamethasone therapy for bacterial meningitis
AJDC
Prednisolone in treatment of pneumococcal meningitis
Trop Geogr Med
Cachectin and tumor necrosis factor as two sides of the same biological coin
Nature
Control of cachectin (tumor necrosis factor) synthesis: mechanism of endotoxin resistance
Science
Influence of blood collecting-systems on concentrations of tumor necrosis factor in serum and plasma
Clin Chem
APACHE II: a severity of disease classification system
Crit Care Med
An expanded definition of the adult respiratory distress syndrome
Am Rev Respir Dis
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Manuscript received October 20; revision accepted December 14.