Pulmonary and systemic inflammatory response in patients with pulmonary infections receiving long-term glucocorticoid therapy

C. Agusti, A. Rañó, X. Filella, J. Angrill, A. Torres (Barcelona, Spain)

Source: Annual Congress 2002 - Clinical aspects of antibiotic and nonantibiotic therapy of pneumonia in the ICU

Session: Clinical aspects of antibiotic and nonantibiotic therapy of pneumonia in the ICU
Session type: Oral Presentation
Number: 230

Abstract

Glucocorticoids (GC) alter immunoregulatory defense mechanisms and may favour the development of different pulmonary infections. We prospectively evaluated 33 patients with pulmonary infections receiving long-term (>30 mg/day for more than a month) GC tretament (LTGCT). Different cytokines in bronchoalveolar lavage (BAL) and serum and C-reactive protein (CRP) in serum were measured and compared with the levels obtained in patients with pulmonary infections but without GC treatment (NGCT) and patients receiving GC for a short period of time (<9 days) (STGCT). Results of the different inflammatory mediators are shown in table. Aspergillus sp (n=9, 31%) and Staphyloccocus sp (n=6, 21%) were the most common causative agents. Conclusions: Pulmonary infections in patients receiving LTGCT show an attenuated local and systemic inflammatory response. Supported by SOCAP/FUCAP

		LTGCT	STCGT	NGCT	p
		N=13	N=11	N=9
BAL	Neutrophils (%)	34 (1-98)	74 (0-99)	100 (79-100)	0.017
	TNF-α (pg/ml)	15 (0-52)	25 (0-53)	53 (0-392)	0.027
	IL-1β (pg/ml)	32 (0-94)	26 (10-170)	56 (14-319)	0.3
	IL-6 (pg/ml)	51 (0-958)	325 (53-4736)	729 (34-8220)	0.007
Serum	TNF-α (pg/ml)	46 (10-82)	25 (10-54)	37 (15-88)	0.28
	IL-1β (pg/ml)	5 (0-12)	0 (0-4)	0 (0-13)	0.32
	IL-6 (pg/ml)	74 (0-116)	89 (9-4300)	980 (97-2600)	0.007
	CRP day 1 (mg/dl)	12 (1.2-25.2)	14 (4-46)	31 (18-58)	0.005
	CRP day 4 (mg/dl)	2.6 (1.1-7.4)	11 (1-26)	22 (9-45)	0.004

Data are presented as median (range).

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C. Agusti, A. Rañó, X. Filella, J. Angrill, A. Torres (Barcelona, Spain). Pulmonary and systemic inflammatory response in patients with pulmonary infections receiving long-term glucocorticoid therapy. Eur Respir J 2002; 20: Suppl. 38, 230

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