Effect of corticosteroids on c-reactive protein in patients with severe community-acquired pneumonia and high inflammatory response

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...

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Autores: Torres, Antoni|||0000-0002-8643-2167, Ceccato, Adrian|||0000-0001-9454-062X, Ferrer, Miquel|||0000-0001-8171-6673, Gabarrús, Albert|||0000-0003-3492-1310, Sibila, Oriol|||0000-0002-4833-6713, Cilloniz, Catia|||0000-0002-4646-9838, Méndez, Raúl|||0000-0001-6300-9836, Menéndez Villanueva, Rosario|||0000-0002-3592-3839, Bermejo-Martin, Jesus F.|||0000-0002-7998-6268, Niederman, Michael S.
Tipo de recurso: artículo
Fecha de publicación:2019
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:286557
Acceso en línea:https://ddd.uab.cat/record/286557
https://dx.doi.org/urn:doi:10.3390/jcm8091461
Access Level:acceso abierto
Palabra clave:Pneumonia
Corticosteroids
Inflammatory response
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spelling Effect of corticosteroids on c-reactive protein in patients with severe community-acquired pneumonia and high inflammatory responseThe effect of lymphopeniaTorres, Antoni|||0000-0002-8643-2167Ceccato, Adrian|||0000-0001-9454-062XFerrer, Miquel|||0000-0001-8171-6673Gabarrús, Albert|||0000-0003-3492-1310Sibila, Oriol|||0000-0002-4833-6713Cilloniz, Catia|||0000-0002-4646-9838Méndez, Raúl|||0000-0001-6300-9836Menéndez Villanueva, Rosario|||0000-0002-3592-3839Bermejo-Martin, Jesus F.|||0000-0002-7998-6268Niederman, Michael S.PneumoniaCorticosteroidsInflammatory responseBackground: 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. 22019-01-0120192019-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/286557https://dx.doi.org/urn:doi:10.3390/jcm8091461reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengInstituto de Salud Carlos III https://doi.org/10.13039/501100004587 PI19/00207open accesshttp://purl.org/coar/access_right/c_abf2Aquest 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.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:2865572026-06-06T12:50:31Z
dc.title.none.fl_str_mv Effect of corticosteroids on c-reactive protein in patients with severe community-acquired pneumonia and high inflammatory response
The effect of lymphopenia
title Effect of corticosteroids on c-reactive protein in patients with severe community-acquired pneumonia and high inflammatory response
spellingShingle Effect of corticosteroids on c-reactive protein in patients with severe community-acquired pneumonia and high inflammatory response
Torres, Antoni|||0000-0002-8643-2167
Pneumonia
Corticosteroids
Inflammatory response
title_short Effect of corticosteroids on c-reactive protein in patients with severe community-acquired pneumonia and high inflammatory response
title_full Effect of corticosteroids on c-reactive protein in patients with severe community-acquired pneumonia and high inflammatory response
title_fullStr Effect of corticosteroids on c-reactive protein in patients with severe community-acquired pneumonia and high inflammatory response
title_full_unstemmed Effect of corticosteroids on c-reactive protein in patients with severe community-acquired pneumonia and high inflammatory response
title_sort Effect of corticosteroids on c-reactive protein in patients with severe community-acquired pneumonia and high inflammatory response
dc.creator.none.fl_str_mv Torres, Antoni|||0000-0002-8643-2167
Ceccato, Adrian|||0000-0001-9454-062X
Ferrer, Miquel|||0000-0001-8171-6673
Gabarrús, Albert|||0000-0003-3492-1310
Sibila, Oriol|||0000-0002-4833-6713
Cilloniz, Catia|||0000-0002-4646-9838
Méndez, Raúl|||0000-0001-6300-9836
Menéndez Villanueva, Rosario|||0000-0002-3592-3839
Bermejo-Martin, Jesus F.|||0000-0002-7998-6268
Niederman, Michael S.
author Torres, Antoni|||0000-0002-8643-2167
author_facet Torres, Antoni|||0000-0002-8643-2167
Ceccato, Adrian|||0000-0001-9454-062X
Ferrer, Miquel|||0000-0001-8171-6673
Gabarrús, Albert|||0000-0003-3492-1310
Sibila, Oriol|||0000-0002-4833-6713
Cilloniz, Catia|||0000-0002-4646-9838
Méndez, Raúl|||0000-0001-6300-9836
Menéndez Villanueva, Rosario|||0000-0002-3592-3839
Bermejo-Martin, Jesus F.|||0000-0002-7998-6268
Niederman, Michael S.
author_role author
author2 Ceccato, Adrian|||0000-0001-9454-062X
Ferrer, Miquel|||0000-0001-8171-6673
Gabarrús, Albert|||0000-0003-3492-1310
Sibila, Oriol|||0000-0002-4833-6713
Cilloniz, Catia|||0000-0002-4646-9838
Méndez, Raúl|||0000-0001-6300-9836
Menéndez Villanueva, Rosario|||0000-0002-3592-3839
Bermejo-Martin, Jesus F.|||0000-0002-7998-6268
Niederman, Michael S.
author2_role author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Pneumonia
Corticosteroids
Inflammatory response
topic Pneumonia
Corticosteroids
Inflammatory response
description 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.
publishDate 2019
dc.date.none.fl_str_mv 2
2019-01-01
2019
2019-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/286557
https://dx.doi.org/urn:doi:10.3390/jcm8091461
url https://ddd.uab.cat/record/286557
https://dx.doi.org/urn:doi:10.3390/jcm8091461
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.relation.none.fl_str_mv Instituto de Salud Carlos III https://doi.org/10.13039/501100004587 PI19/00207
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
reponame_str Dipòsit Digital de Documents de la UAB
collection Dipòsit Digital de Documents de la UAB
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