Cosyntropin testing does not predict response to glucocorticoids in community-acquired pneumonia in a randomized controlled trial.

Blum, Claudine Angela; Schuetz, Philipp; Nigro, Nicole; Winzeler, Bettina; Arici, Birsen; Refardt, Julie; Urwyler, Sandrine Andrea; Rodondi, Nicolas; Blum, Manuel Raphael; Briel, Matthias; Mueller, Beat; Christ-Crain, Mirjam (2018). Cosyntropin testing does not predict response to glucocorticoids in community-acquired pneumonia in a randomized controlled trial. (In Press). Clinical endocrinology Blackwell Scientific Publications 10.1111/cen.13907

[img] Text
Blum ClinEndocrinol 2018.pdf - Accepted Version
Restricted to registered users only until 29 November 2019.
Available under License Publisher holds Copyright.

Download (607kB) | Request a copy

OBJECTIVE Glucocorticoids have been shown to improve outcome in community-acquired pneumonia (CAP). However, glucocorticoids have potential side-effects, and treatment response may vary. It is thus crucial to select patients with high likelihood to respond favorably. In critical illness, cosyntropin testing is recommended to identify patients in need for glucocorticoids. We investigated whether consyntropin testing predicts treatment response to glucocorticoids in CAP. DESIGN PREDEFINED SECONDARY ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL: PATIENTS: HOSPITALIZED PATIENTS WITH CAP: MEASUREMENTS: We performed 1μg cosyntropin tests in a randomized trial comparing prednisone 50mg for seven days to placebo. We investigated whether subgroups based on baseline and stimulated cortisol levels responded differently to glucocorticoids with regards to time to clinical stability (TTCS) and other outcomes by inclusion of interaction terms into statistical models. RESULTS 326 patients in the prednisone and 309 patients in the placebo group were evaluated. Neither basal cortisol nor a Δcortisol<250nmol/L after stimulation nor the combination of basal cortisol and Δcortisol predicted treatment response as measured by TTCS (all p for interaction>0.05). Similarly, we found no effect modification with respect to mortality, rehospitalization, antibiotic treatment duration or CAP-related complications (all p for interaction>0.05). However, glucocorticoids had a stronger effect on shortening length of hospital stay in patients with a baseline cortisol of ≥938 nmol/L (p for interaction=0.015). CONCLUSIONS Neither baseline nor stimulated cortisol after low-dose cosyntropin testing at a dose of 1 μg predicted glucocorticoid responsiveness in mild to moderate CAP. A treatment decision for or against adjunct glucocorticoids in CAP should not be made depending on cortisol values or cosyntropin testing results. This article is protected by copyright. All rights reserved.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Rodondi, Nicolas and Blum, Manuel

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0300-0664

Publisher:

Blackwell Scientific Publications

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

07 Dec 2018 13:27

Last Modified:

11 Dec 2018 08:37

Publisher DOI:

10.1111/cen.13907

PubMed ID:

30485501

Uncontrolled Keywords:

ACTH test Community-acquired Pneumonia Critical-Illness-related Corticosteroid Insufficiency adrenal function cosyntropin test glucocorticoids

BORIS DOI:

10.7892/boris.122332

URI:

https://boris.unibe.ch/id/eprint/122332

Actions (login required)

Edit item Edit item
Provide Feedback