Cosyntropin testing does not predict response to glucocorticoids in community-acquired pneumonia in a randomized controlled trial.
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BORIS DOI
Publisher DOI
PubMed ID
30485501
Description
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.
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.
Date of Publication
2019-09
Publication Type
Article
Subject(s)
600 - Technology::610 - Medicine & health
300 - Social sciences, sociology & anthropology::360 - Social problems & social services
Keyword(s)
ACTH test Community-acquired Pneumonia Critical-Illness-related Corticosteroid Insufficiency adrenal function cosyntropin test glucocorticoids
Language(s)
en
Contributor(s)
Blum, Claudine Angela | |
Schuetz, Philipp | |
Nigro, Nicole | |
Winzeler, Bettina | |
Arici, Birsen | |
Refardt, Julie | |
Urwyler, Sandrine Andrea | |
Briel, Matthias | |
Mueller, Beat | |
Christ-Crain, Mirjam |
Additional Credits
Berner Institut für Hausarztmedizin (BIHAM)
Universitätsklinik für Allgemeine Innere Medizin
Series
Clinical endocrinology
Publisher
Blackwell Scientific Publications
ISSN
0300-0664
Access(Rights)
open.access