Reduction of the systemic inflammatory response in patients with CAP treated with corticosteroids improves clinical outcome and reduces mortality and ICU admittance
Corticosteroids can improve clinical outcome in patients with pneumonia. However, little is known about the effects of corticosteroids on systemic cytokine levels in these patients or which patients benefit most from corticosteroid therapy. Hospitalized, non-immunocompromised patients with CAP were randomly assigned to a 4-day course of dexamethasone (5 mg once a day) or placebo. Serum levels of IL-1Ra, IL-6, IL-8, IL-10, IL-17, TNF-α, INF-γ, MIP and MCP were measured at various time-points during hospital stay. We enrolled 304 patients. The median levels of IL-6, MCP, TNF-a, IL-8, and IL1ra, all were significantly lower (p When IL6, IL-8 and MCP, being the most prominent proinflammatory cytokines were combined, patients who had all three cytokines above a predefined cut-off point benefited most from dexamethasone therapy. In the dexamethasone group only 2 patients (8,3%) died, while in the placebo group 8 patients (47%) died (p: Conclusion: Proinflammatory cytokines and chemokines decreased more rapidly in dexamethasone treated patients compared to placebo treated patients. This effect was most evident in patients with an atypical bacterium. In patients with highest cytokine response, dexamethasone showed a reduction in mortality and ICU admittance.