Tuesday January 13, 2009
Baseline Cortisol in Severe Community-Acquired Pneumonia

The aim of the study was to investigate the predictive value of adrenal response in patients with severe CAP admitted to the ICU.

Methods: 72 patients with severe CAP admitted to the ICU were evaluated. Following were measured in first 24 hours

• Baseline and postcorticotropin cortisol levels
• C-reactive protein (CRP),
• d-dimer,
• clinical variables,
• sequential organ failure assessment (SOFA) score
• APACHE (acute physiology and chronic health evaluation) II, and
• CURB-65 (confusion, urea nitrogen, respiratory rate, BP, age ≥ 65 years) score

The major outcome measure was hospital mortality.

Results:

• Baseline cortisol levels were 18.1 μg/dL and the difference between baseline and postcorticotropin cortisol after 250 μg of corticotropin was 19 μg/dL
• Baseline cortisol levels presented positive correlations with scores of disease severity, including CURB-65, APACHE II, and SOFA
• Cortisol levels in nonsurvivors were higher than in survivors.
• CIRCI (critical illness-related corticosteroid insufficiency) was diagnosed in 29 patients (40.8%)
• In univariate analysis, baseline cortisol, CURB-65, and APACHE II were predictors of death.
• The discriminative ability of baseline cortisol for in-hospital mortality was better than APACHE II, CURB-65, SOFA, d-dimer, or CRP.

Conclusion: Baseline cortisol levels are better predictors of severity and outcome in severe CAP than postcorticotropin cortisol or routinely measured laboratory parameters or scores as APACHE II, SOFA, and CURB-65.

Reference: Click to get abstract

Adrenal Response in Severe Community-Acquired Pneumonia - Chest 134:947-954; November 2008