Annual General Meeting of the Irish Thoracic Society - IJMS | Irish ...

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SESSION THREE ONE
ANNUAL MEETING OF THE IRISH THORACIC SOCIETY • 11 - 12 November 2005 • WESTWOOD HOUSE HOTEL, GALWAY
ANNUAL MEETING OF THE IRISH THORACIC SOCIETY • 11 - 12 November 2005 • WESTWOOD HOUSE HOTEL, GALWAY
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SESSION
SESSION THREE ONE
Lung Infection / Mechanisms
3.35
Adrenal insufficiency in patients with community
acquired pneumonia
3.37
Thalidomide treatment in chronic lung infection
Introduction
The role of adrenal insufficiency and physiological
corticosteroid replacement has recently been
reviewed in sepsis and in pneumonia in the intensive
care (ICU) setting. We hypothesised that adrenal
response would be affected in patients managed
for community acquired pneumonia (CAP) outside
the ICU and that this would correlate with severity
of inflammatory response as measured by the proinflammatory
cytokine IL-6.
Method
19 patients with CAP were assessed within 24 hours
of admission. Severity of illness was assessed using
the CURB-65 score and Pneumonia Severity Index.
A short synacthen test was performed and a serum
IL-6 was measured.
Results
One patient was excluded because of treatment with
intravenous steroids. 50 % of the remaining patients
had relative adrenal insufficiency (i.e. nonresponders)
as defined by a cortisol response of 248nmol/L or
less. Severity of pneumonia did not differ between
the responders and the nonresponders. No deaths
occurred in either group. The average hospital stay
was 2 days longer in the nonresponder group. There
was a recognised trend towards a higher IL-6 in the
responders compared with the non-responder group.
Conclusions
There is a high incidence of relative adrenal
insufficiency in patients admitted with community
acquired pneumonia and managed outside the ICU.
In this study we found adrenal insufficiency to be
associated with a trend towards longer inpatient
stay and higher IL-6 level.
E Kelly, NG McElvaney,
SJ O’Neill
Dept of Respiratory
research, Beaumont
Hospital, Dublin
Introduction
We have previously reported that chronic airway
infection causes angiogenesis in the pulmonary
circulation. Inhibition of angiogenesis ameliorates
chronic inflammatory diseases including rheumatoid
arthritis and inflammatory bowel disease. We
hypothesized that inhibition of angiogenesis with
thalidomide would reduce inflammatory damage in
chronic lung infection.
Methods
Adult male rats were anaesthetised and inoculated
intratracheally with Pseudomonas aeruginosa
incorporated into agar beads to induce chronic
infection. Infected rats were treated with
thalidomide, an angiogenesis inhibitor, or vehicle. A
third group were inoculated with sterile agar beads.
12 days post-inoculation, rats were anaesthetised and
their lungs isolated and fixed at standard pressure.
Results
Both infected groups had increased BAL neutrophils.
There was no significant difference in the tissue
volume in the gas exchange region of the infected
vehicle and infected thalidomide groups, although
both were increased compared to the sterile group.
In the infected thalidomide group, the volume of
airspace in the gas exchange region was reduced
compared to the infected vehicle group.
Conclusions
Thalidomide decreased compliance in the lungs
suggesting that it augmented damage due to
infection.
STERILE (N=8) INFECTED VEHICLE (N=9) INFECTED THALIDOMIDE (N=9)
BAL Neutrophils (x103/ml) 2.8 (1.4) 34.4 (12.5)* 35.6 (18.1)*
Tissue volume (cm3) 1.86 (0.1) 2.33 (0.11)* 2.30 (0.13)*
Airspace volume (cm3) 2.03 (0.12) 2.20 (0.15) 1.80 (0.09)†
Y Gunning, N Hopkins,
P McLoughlin
UCD, School of
Medicine & Medical
Science, Conway
Institute
HRB Funded
3.36
Predicting bacteraemia in patients with community
acquired pneumonia
Values are means (SEM). * Significant difference from sterile group (P