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Time-dependent association of glucocorticoids with adverse outcome in
community-acquired pneumonia: a 6-year prospective cohort study
#MMPMID28335807
Nickler M
; Ottiger M
; Steuer C
; Kutz A
; Christ-Crain M
; Zimmerli W
; Thomann R
; Hoess C
; Henzen C
; Bernasconi L
; Huber A
; Mueller B
; Schuetz P
Crit Care
2017[Mar]; 21
(1
): 72
PMID28335807
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BACKGROUND: The hypothalamic-pituitary-adrenal stress axis plays a crucial role
in community-acquired pneumonia (CAP), with high cortisol being associated with
disease severity and corticosteroid treatment resulting in earlier time to
recovery. Our aim in the present study was to compare different glucocorticoid
hormones, including cortisol, 11-deoxycortisol, cortisone, and corticosterone,
regarding their association with short- and long-term adverse outcomes in a
well-defined CAP cohort. METHODS: We prospectively followed 285 patients with CAP
from a previous Swiss multicenter trial for a median of 6.1 years and measured
different admission glucocorticoid serum levels by liquid chromatography coupled
with tandem mass spectrometry. We used adjusted Cox regression models to
investigate associations between admission hormone levels and all-cause mortality
at different time points. RESULTS: Mortality was 5.3% after 30 days and increased
to 47.3% after 6 years. High admission cortisol was associated with adverse
outcome after 30 days (adjusted OR 3.85, 95% CI 1.10-13.49, p?=?0.035). In the
long term (i.e.,), however, high admission cortisol was associated with better
survival (adjusted HR after 3 years 0.53, 95% CI 0.32-0.89, p?=?0.017; adjusted
HR after 6 years 0.57, 95% CI 0.36-0.90, p?=?0.015). Compared with
11-deoxycortisol, cortisone, and corticosterone, cortisol showed the highest
association with mortality. CONCLUSIONS: Among different glucocorticoid hormones,
cortisol showed the highest association with mortality in CAP. Whereas a more
pronounced glucocorticoid stress response on hospital admission was associated
with higher short-term adverse outcome, long-term outcome was favorable in these
patients. These data should support the correct interpretation of glucocorticoid
blood data.
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