Low-dose hydrocortisone reduces norepinephrine duration in severe burn patients: a randomized clinical trial

INTRODUCTION: The aim of this study was to assess the effect of low-dose corticosteroid therapy in reducing shock duration after severe burn. METHODS: A placebo-controlled, double-blind, randomized clinical trial (RCT) was performed on two parallel groups in the burn intensive care unit (ICU). Patients were randomized to receive either low-dose corticosteroid therapy or placebo for seven days. A corticotropin test was performed at the time of randomization, before the administration of the treatment dose. Thirty-two severely burned patients with refractory shock (>0.5 μg/kg/min of norepinephrine) were prospectively included in the study. RESULTS: We included 12 patients in the hydrocortisone-treated group and 15 patients in the placebo group in the final analysis. Among these patients, 21 were nonresponders to the corticotropin test. Median norepinephrine treatment duration (primary objective) was significantly lower in the corticosteroid-treated versus the placebo group (57 hours versus 120 hours, P = 0.035). The number of patients without norepinephrine 72 hours after inclusion was significantly lower in the treated group (P = 0.003, log-rank test analysis). The total quantities of norepinephrine administered to patients were lower in the hydrocortisone-treated versus the placebo group (1,205 μg/kg (1,079 to 2,167) versus 1,971 μg/kg (1,535 to 3,893), P = 0.067). There was no difference in terms of ICU or hospital length of stay, sepsis incidence, cicatrization or mortality. CONCLUSIONS: In this placebo-controlled, randomized, double-blind clinical trial, we show for the first time that the administration of low-dose hydrocortisone in burn patients with severe shock reduces vasopressor administration. TRIAL REGISTRATION: Clinicaltrial.gov NCT00149123. Registered 6 September 2005. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-015-0740-0) contains supplementary material, which is available to authorized users

Programme de recherches interdisciplinaires « Vérité et fiction »

Stéphane Breton, Jean-Paul Colleyn, André Gunthert, Jean-Claude Penrad, Annick Bouleau, Sabine Chalvon, Daniel Dayan, Renaud Dulong, Éliane de Latour, Catarina Pasqualino, Dominique Pasquier, Marc-Henri Piault, Jean-Pierre Bertin-Maghit, Jacqueline Chervin, Emmannuel Grimaud, Roger Odin, Laurence Allard Allard, Gilles Saussier, Elodie Perreau Nous avons poursuivi nos travaux sur la tension (majeure), entre la vérité et la fiction dans les formes d’expression audiovisuelles. Roger Odin (Univer..

Programme de recherches interdisciplinaires « Vérité et fiction »

Stéphane Breton, Jean-Paul Colleyn, André Gunthert, Jean-Claude Penrad, Annick Bouleau, Sabine Chalvon, Daniel Dayan, Renaud Dulong, Éliane de Latour, Catarina Pasqualino, Dominique Pasquier, Marc-Henri Piault, Jean-Pierre Bertin-Maghit, Jacqueline Chervin, Emmannuel Grimaud, Roger Odin, Laurence Allard Allard, Gilles Saussier, Elodie Perreau Nous avons poursuivi nos travaux sur la tension (majeure), entre la vérité et la fiction dans les formes d’expression audiovisuelles. Roger Odin (Univer..

Integrated clustering of multiple immune marker trajectories reveals different immunotypes in severely injured patients

International audienceAbstract Background The immune response of critically ill patients, such as those with sepsis, severe trauma, or major surgery, is heterogeneous and dynamic, but its characterization and impact on outcomes are poorly understood. Until now, the primary challenge in advancing our understanding of the disease has been to concurrently address both multiparametric and temporal aspects. Methods We used a clustering method to identify distinct groups of patients, based on various immune marker trajectories during the first week after admission to ICU. In 339 severely injured patients, we initially longitudinally clustered common biomarkers (both soluble and cellular parameters), whose variations are well-established during the immunosuppressive phase of sepsis. We then applied this multi-trajectory clustering using markers composed of whole blood immune-related mRNA. Results We found that both sets of markers revealed two immunotypes, one of which was associated with worse outcomes, such as increased risk of hospital-acquired infection and mortality, and prolonged hospital stays. This immunotype showed signs of both hyperinflammation and immunosuppression, which persisted over time. Conclusion Our study suggest that the immune system of critically ill patients can be characterized by two distinct longitudinal immunotypes, one of which included patients with a persistently dysregulated and impaired immune response. This work confirms the relevance of such methodology to stratify patients and pave the way for further studies using markers indicative of potential immunomodulatory drug targets. Graphical Abstrac