Adrenal response in severe community-acquired pneumonia: Impact on outcomes and disease severity.
Chest. 2008 Aug 27;
Authors: Salluh JI, Bozza FA, Soares M, Verdeal JC, Castro-Faria-Neto HC, Lapa E Silva JR, Bozza PT
Background High cortisol levels are frequent in patients with severe infections. However, the predictive value of total cortisol and of the presence of critical illness related corticosteroid insufficiency (CIRCI) in severe community-acquired pneumonia (CAP) remains to be thoroughly evaluated. The aim of this study was to investigate the predictive value of adrenal response in patients with severe CAP admitted to the ICU. Methods Baseline and post-corticotropin cortisol levels C-reactive protein, D-dimer, clinical variables, SOFA, APACHE II and the CURB-65 score were measured in the first 24 hours. Results are shown as median (25%-75% interquartile range (IQR). The major outcome measure was hospital mortality. Results Seventy-two patients with severe CAP admitted to the ICU were evaluated. Baseline cortisol levels were 18.1 (14.4-26.7) mug/dL and delta cortisol after 250mug of corticotropin was 19 (12.8-27) mug/dL. Baseline cortisol levels presented positive correlations with scores of disease severity including CURB-65, APACHE II and SOFA (P <0.05). Cortisol levels in non-survivors were higher than in survivors. CIRCI was diagnosed in 29 (40.8%) patients. In univariate analysis, baseline cortisol, CURB-65 and APACHE II were predictors of death. The discriminative ability of baseline cortisol [Area under ROC curve=0.77 (95% CI, 0.65-0.90) - best cutoff for cortisol was 25.7mug/dL] for in-hospital mortality was better than APACHE II, CURB-65, SOFA, D-dimer or C-reactive protein. Conclusions Baseline cortisol levels are better predictors of severity and outcome in severe CAP than post-corticotropin cortisol or routinely measured laboratory parameters or scores as APACHE II, SOFA and CURB-65. Condensed abstract High cortisol levels are present in a significant proportion of patients with severe community-acquired pneumonia. In these patients, cortisol has the ability to predict mortality and correlates with disease severity. Prognostic performance of total baseline cortisol is better than APACHE II, CURB-65, D-dimer, delta cortisol and C-reactive protein.
PMID: 18753464 [PubMed - as supplied by publisher]