Randomized trial: inflammatory response to corticoids versus placebo in moderate and severe bronchiolitis. COTHEB study
Rev. cuba. pediatr
; 93(4)dic. 2021.
Article
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LILACS-Express
| LILACS
| ID: biblio-1409075
Responsible library:
CU1.1
ABSTRACT
ABSTRACT Introduction:
The use of corticosteroids has been shown not to improve the prognosis of patients with bronchiolitis, but it could be assumed that steroids will reduce inflammation.Objective:
This study aimed to assess whether corticoid therapy influenced the inflammatory and clinical response of critically ill infants.Methods:
Prospective, randomized, double blind placebo-controlled trial of glucocorticoids (GCT) in infants of less than 12 months with severe or moderate bronchiolitis. Patients were randomized to receive systemic corticoid therapy (low dose for 7 days) or placebo. The main outcomes were a) levels of lymphocyte subsets; b) levels of IL-2, IL-12, and IFNγ as pro-inflammatory factors, and c) levels of IL-4 and IL-10 as anti-inflammatory response. Secondary outcomes related with the clinical response were also analyzed.Results:
97 patients were randomized. Evolution of lymphocyte subsets was similar in both groups. Pro-inflammatory interleukins and interferon decreased, but without differences. Anti-inflammatory interleukins showed a significant decrease from baseline to the end of the study, and IL-10 values were significantly lower (p = 0.046) in the GCT group [1.82 pg/ml (1.2-3.5)] vs non-GCT [4 pg/ml (1.5-6.3)]. GCT group showed a lower time of mechanical ventilation and of hospitalization, but without statistically significant differences. No cases of severe adverse reaction to steroids were detected.Conclusions:
Administration of systemic GCT did not modify the inflammatory nor the clinical response of patients with severe bronchiolitis, except for IL-10 levels that were significantly lower in the GCT group. This can open a line of investigation about the relation of IL-10 and response to bronchiolitis.RESUMEN
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