Low-dose methylprednisolone treatment in critically ill patients with severe community-acquired pneumonia

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dc.contributor.authorMeduri, G. Umbertoen
dc.contributor.authorShih, Mei-Chiungen
dc.contributor.authorBridges, Lisaen
dc.contributor.authorMartin, Thomas J.en
dc.contributor.authorEl-Solh, Alien
dc.contributor.authorSeam, Nitinen
dc.contributor.authorDavis-Karim, Anneen
dc.contributor.authorUmberger, Rebaen
dc.contributor.authorAnzueto, Antonioen
dc.contributor.authorSriram, Peruvembaen
dc.contributor.authorLan, Charlieen
dc.contributor.authorRestrepo, Marcos I.en
dc.contributor.authorGuardiola, Juan J.en
dc.contributor.authorBuck, Teresaen
dc.contributor.authorJohnson, David P.en
dc.contributor.authorSuffredini, Anthonyen
dc.contributor.authorBell, W. Andrewen
dc.contributor.authorLin, Juliaen
dc.contributor.authorZhao, Lanen
dc.contributor.authorUyeda, Laurenen
dc.contributor.authorNielsen, Lorien
dc.contributor.authorHuang, Grant D.en
dc.date.accessioned2022-09-22T14:20:12Zen
dc.date.available2022-09-22T14:20:12Zen
dc.date.issued2022-08-01en
dc.date.updated2022-09-22T14:08:25Zen
dc.description.abstractPurpose: Severe community-acquired pneumonia (CAP) requiring intensive care unit admission is associated with significant acute and long-term morbidity and mortality. We hypothesized that downregulation of systemic and pulmonary inflammation with prolonged low-dose methylprednisolone treatment would accelerate pneumonia resolution and improve clinical outcomes. Methods: This double-blind, randomized, placebo-controlled clinical trial recruited adult patients within 72–96 h of hospital presentation. Patients were randomized in 1:1 ratio; an intravenous 40 mg loading bolus was followed by 40 mg/day through day 7 and progressive tapering during the 20-day treatment course. Randomization was stratified by site and need for mechanical ventilation (MV) at the time of randomization. Outcomes included a primary endpoint of 60-day all-cause mortality and secondary endpoints of morbidity and mortality up to 1 year of follow-up. Results: Between January 2012 and April 2016, 586 patients from 42 Veterans Affairs Medical Centers were randomized, short of the 1420 target sample size because of low recruitment. 584 patients were included in the analysis. There was no significant difference in 60-day mortality between the methylprednisolone and placebo arms (16% vs. 18%; adjusted odds ratio 0.90, 95% CI 0.57–1.40). There were no significant differences in secondary outcomes or complications. Conclusions: In patients with severe CAP, prolonged low-dose methylprednisolone treatment did not significantly reduce 60-day mortality. Treatment was not associated with increased complications.en
dc.description.versionPublished versionen
dc.format.extentPages 1009-1023en
dc.format.mimetypeapplication/pdfen
dc.identifier.doihttps://doi.org/10.1007/s00134-022-06684-3en
dc.identifier.eissn1432-1238en
dc.identifier.issn0342-4642en
dc.identifier.issue8en
dc.identifier.other10.1007/s00134-022-06684-3 (PII)en
dc.identifier.pmid35723686en
dc.identifier.urihttp://hdl.handle.net/10919/111963en
dc.identifier.volume48en
dc.language.isoenen
dc.publisherSpringeren
dc.relation.urihttps://www.ncbi.nlm.nih.gov/pubmed/35723686en
dc.rightsPublic Domain (U.S.)en
dc.rights.urihttp://creativecommons.org/publicdomain/mark/1.0/en
dc.subjectESCAPe Study Groupen
dc.subjectCommunity-acquired pneumoniaen
dc.subjectGlucocorticoidsen
dc.subjectIntensive careen
dc.subjectMethylprednisoloneen
dc.subjectRandomized clinical trialen
dc.subjectPneumoniaen
dc.subjectClinical Trials and Supportive Activitiesen
dc.subjectClinical Researchen
dc.subjectPneumonia & Influenzaen
dc.subjectLungen
dc.subject6 Evaluation of treatments and therapeutic interventionsen
dc.subject6.1 Pharmaceuticalsen
dc.subjectRespiratoryen
dc.subject3 Good Health and Well Beingen
dc.subject.meshHumansen
dc.subject.meshCommunity-Acquired Infectionsen
dc.subject.meshPneumoniaen
dc.subject.meshCritical Illnessen
dc.subject.meshMethylprednisoloneen
dc.subject.meshTreatment Outcomeen
dc.subject.meshRespiration, Artificialen
dc.subject.meshAdulten
dc.titleLow-dose methylprednisolone treatment in critically ill patients with severe community-acquired pneumoniaen
dc.title.serialIntensive Care Medicineen
dc.typeArticle - Refereeden
dc.type.dcmitypeTexten
dc.type.otherJournal Articleen
dcterms.dateAccepted2022-03-16en
pubs.organisational-group/Virginia Techen
pubs.organisational-group/Virginia Tech/VT Carilion School of Medicineen
pubs.organisational-group/Virginia Tech/VT Carilion School of Medicine/Internal Medicineen
pubs.organisational-group/Virginia Tech/VT Carilion School of Medicine/Internal Medicine/General IMen

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