Value of glucocorticoid steroids in the treatment of patients with severe community-acquired pneumonia complicated with septic shock / 中华危重病急救医学

ABSTRACT

Objective To discuss the value of glucocorticoid steroids (GCs) in the treatment of patients with severe community-acquired pneumonia (SCAP) complicated with septic shock.Methods A prospectively controlled randomized trial was conducted.Fifty-eight SCAP patients complicated with septic shock admitted to emergency intensive care unit (ICU) of China-Japan Friendship Hospital from May 2014 to February 2016 were enrolled.The patients were randomly divided into conventional treatment group (n =29) and GCs group (n =29).Fluid resuscitation,vasopressors,mechanical ventilation if needed,antibiotics and other general treatment including symptomatic treatment and eliminating phlegm were given to patients in both groups.Beside the treatment mentioned above,80 mg methylprednisolone once a day for 7 days was added to patients in GCs group.The changes in oxygenation index (PaO2/FiO2) and C-reactive protein (CRP) at 1,4,8 days after treatment as well as the imaging improvement in both groups were observed.Discharge or death was set as a cut-off point,the average time of temperature controlling,duration of mechanical ventilation,time of vasopressors usage and 28-day mortality were observed.The incidence of hyperglycemia,infection and hemorrhage of digestive tract were observed.Results There were no statistically differences in gender,age and body mass between the two groups,indicating that baseline data for the two groups were balanced.PaO2/FiO2 after treatment in the two groups was gradually increased,and it was significantly higher at 8 days after treatment in GCs group than that of conventional treatment group [mmHg (1 mmHg =0.133 kPa)426.46 ± 86.97 vs.363.00 ± 83.96,P ＜ 0.05].CRP after treatment in the two groups was gradually decreased,and it was significantly lower at 4 days and 8 days after treatment in GCs group than that of conventional treatment group (mg/L95.78 ± 47.38 vs.124.72 ± 51.01,57.60 ± 47.44 vs.88.85 ± 48.18,both P ＜ 0.05).Radiographic imaging improved rate at 4 days and 8 days after treatment in GCs group was significantly higher than that of conventional treatment group (55.2％ vs.27.6％,75.9％ vs.51.7％,both P ＜ 0.05),and average time of temperature controlling (days3.94 ± 2.39 vs.7.22 ± 3.11),time of vasopressors usage (hours13.64 ± 6.47 vs.28.34 ± 12.56),and the average hospitalization days (days28.50 ± 8.61 vs.36.21 ± 15.26)in GCs group were significantly shorter than those of conventional treatment group (all P ＜ 0.01).There was no significant difference in duration of mechanical ventilation between GCs group and conventional treatment group (days13.39 ± 2.62 vs.16.16 ± 5.85,P ＞ 0.05).28-day mortality of the two groups was 10.3％ equally (P ＞ 0.05).No significant differences in the incidences of hyperglycemia (10.3％ vs.6.9％),infection (51.7％ vs.55.2％) and gastrointestinal bleeding (3.4％ vs.0) were found between GCs group and conventional treatment group (all P ＞ 0.05),indicating that glucocorticoid steroids could not increase the common side effects.Conclusion GCs is an important adjuvant treatment of patients with SCAP complicated with septic shock.