Role of glucocorticoids on inflammatory response in nonimmunosuppressed patients with pneumonia: a pilot study

The aim of the study was to assess the potential role of glucocorticoids (G C) in modulating systemic and pulmonary inflammatory responses in mechanica lly ventilated patients with severe pneumonia. Twenty mechanically ventilated patients with pneumonia treated at a respira tory intensive care unit (RICU) of a 1,000-bed teaching hospital were prosp ectively studied. All patients had received prior antimicrobial treatment. Eleven patients received Hospital Clinic GC (mean+/-SD dose of i.v. methylp rednisolone 677+/-508 mg for 9+/-7 days), mainly for bronchial dilatation. Serum and bronchoalveolar lavage fluid (BALF) tumour necrosis sis factor (T NF)-alpha, interleukin (IL)-1 beta, IL-6 and C-reactive protein levels were measured in all patients. The inflammatory response was attenuated in patients receiving GC, both sys temically (IL-6 1,089+/-342 versus 630+/-385 pg.mL(-1), p=0.03; C-reactive protein 34+/-15 versus 19+/-15 mg.L-1 p=0.04) and locally in BALF (TNF-alph a 118+/-50 versus 24+/-5 pg.ml(-1), p= 0.05; neutrophil count: 2.4+/-1.1 x 10(9) cells.L-1 (93+/-3%) versus 1.9+/-1.8 x 10(9) cells.L-1 (57+/-16%), p= 0.03). Four of the 11 (36%) patients receiving GC died compared to six (67% ) who were not receiving GC (p=0.37). The present pilot study suggests that glucocorticoids decrease systemic and lung inflammatory responses in mechanically ventilated patients with sever e pneumonia receiving antimicrobial treatment.