Transcriptome modulation by hydrocortisone in severe burn shock: ancillary analysis of a prospective randomized trial - Université Claude Bernard Lyon 1 Accéder directement au contenu
Article Dans Une Revue Critical Care Année : 2017

Transcriptome modulation by hydrocortisone in severe burn shock: ancillary analysis of a prospective randomized trial

Résumé

Background: Despite shortening vasopressor use in shock, hydrocortisone administration remains controversial, with potential harm to the immune system. Few studies have assessed the impact of hydrocortisone on the transcriptional response in shock, and we are lacking data on burn shock. Our objective was to assess the hydrocortisone-induced transcriptional modulation in severe burn shock, particularly modulation of the immune response. Methods: We collected whole blood samples during a randomized controlled trial assessing the efficacy of hydrocortisone administration in burn shock. Using whole genome microarrays, we first compared burn patients (n = 32) from the placebo group to healthy volunteers to describe the transcriptional modulation induced by burn shock over the first week. Then we compared burn patients randomized for either hydrocortisone administration or placebo, to assess hydrocortisone-induced modulation. Results: Study groups were similar in terms of severity and major outcomes, but shock duration was significantly reduced in the hydrocortisone group. Many genes (n = 1687) were differentially expressed between burn patients and healthy volunteers, with 85% of them exhibiting a profound and persistent modulation over seven days. Interestingly, we showed that hydrocortisone enhanced the shock-associated repression of adaptive, but also innate immunity. Conclusions: We found that the initial host response to burn shock encompasses wide and persistent modulation of gene expression, with profound modulation of pathways associated with metabolism and immunity. Importantly, hydrocortisone administration may worsen the immunosuppression associated with severe injury. These data should be taken into account in the risk ratio of hydrocortisone administration in patients with inflammatory shock.
Fichier principal
Vignette du fichier
s13054-017-1743-9.pdf (1.62 Mo) Télécharger le fichier
Origine Fichiers éditeurs autorisés sur une archive ouverte

Dates et versions

hal-04051074 , version 1 (29-03-2023)

Identifiants

Citer

Jonathan Plassais, Fabienne Venet, Marie-Angélique Cazalis, Diane Le Quang, Alexandre Pachot, et al.. Transcriptome modulation by hydrocortisone in severe burn shock: ancillary analysis of a prospective randomized trial. Critical Care, 2017, 21 (1), pp.158. ⟨10.1186/s13054-017-1743-9⟩. ⟨hal-04051074⟩

Collections

HCL UNIV-LYON1 UDL
7 Consultations
9 Téléchargements

Altmetric

Partager

Gmail Mastodon Facebook X LinkedIn More