PMID- 18753464
OWN - NLM
STAT- MEDLINE
DCOM- 20081202
LR  - 20170529
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 134
IP  - 5
DP  - 2008 Nov
TI  - Adrenal response in severe community-acquired pneumonia: impact on outcomes and 
      disease severity.
PG  - 947-954
LID - S0012-3692(08)60354-2 [pii]
LID - 10.1378/chest.08-1382 [doi]
AB  - 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 postcorticotropin cortisol levels 
      C-reactive protein (CRP), d-dimer, clinical variables, sequential organ failure 
      assessment (SOFA), APACHE (acute physiology and chronic health evaluation) II, 
      and CURB-65 (confusion, urea nitrogen, respiratory rate, BP, age > or = 65 years) 
      scores were measured in the first 24 h. Results are shown as median 
      (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 microg/dL (IQR, 14.4 to 26.7 microg/dL), and 
      the difference between baseline and postcorticotropin cortisol after 250 microg 
      of corticotropin was 19 microg/dL (IQR, 12.8 to 27 microg/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 nonsurvivors were 
      higher than in survivors. CIRCI 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 (area under receiver 
      operating characteristic curve, 0.77; 95% confidence interval, 0.65 to 0.90; best 
      cutoff for cortisol, 25.7 microg/dL) for in-hospital mortality was better than 
      APACHE II, CURB-65, SOFA, d-dimer, or CRP. CONCLUSIONS: 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.
FAU - Salluh, Jorge I F
AU  - Salluh JIF
AD  - Intensive Care Unit, Instituto Nacional de Cancer, Fiocruz. Electronic address: 
      jorgesalluh@yahoo.com.br.
FAU - Bozza, Fernando A
AU  - Bozza FA
AD  - Instituto de Pesquisa Clinica Evandro Chagas, Fiocruz; Laboratory of 
      Immunopharmacology, Instituto Oswaldo Cruz, Fiocruz.
FAU - Soares, Marcio
AU  - Soares M
AD  - Intensive Care Unit, Instituto Nacional de Cancer, Fiocruz.
FAU - Verdeal, Juan Carlos R
AU  - Verdeal JCR
AD  - Intensive Care Unit, Hospital Barra D'or, Universidade Federal do Rio de Janeiro, 
      Rio de Janeiro, Brazil.
FAU - Castro-Faria-Neto, Hugo C
AU  - Castro-Faria-Neto HC
AD  - Laboratory of Immunopharmacology, Instituto Oswaldo Cruz, Fiocruz.
FAU - Lapa E Silva, Jose Roberto
AU  - Lapa E Silva JR
AD  - Pulmonary Diseases Department, Universidade Federal do Rio de Janeiro, Rio de 
      Janeiro, Brazil.
FAU - Bozza, Patricia T
AU  - Bozza PT
AD  - Intensive Care Unit, Instituto Nacional de Cancer, Fiocruz.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20080827
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Hormones)
RN  - 9002-60-2 (Adrenocorticotropic Hormone)
RN  - WI4X0X7BPJ (Hydrocortisone)
SB  - IM
MH  - Adrenal Glands/*metabolism
MH  - Adrenocorticotropic Hormone/administration & dosage/therapeutic use
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Brazil/epidemiology
MH  - Community-Acquired Infections/blood/drug therapy/mortality
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Follow-Up Studies
MH  - Hormones/administration & dosage/therapeutic use
MH  - Hospital Mortality
MH  - Humans
MH  - Hydrocortisone/*blood
MH  - Male
MH  - Middle Aged
MH  - Pneumonia, Bacterial/*blood/drug therapy/mortality
MH  - Prognosis
MH  - ROC Curve
MH  - Respiratory Care Units
MH  - Retrospective Studies
MH  - Severity of Illness Index
EDAT- 2008/08/30 09:00
MHDA- 2008/12/17 09:00
CRDT- 2008/08/30 09:00
PHST- 2008/08/30 09:00 [pubmed]
PHST- 2008/12/17 09:00 [medline]
PHST- 2008/08/30 09:00 [entrez]
AID - S0012-3692(08)60354-2 [pii]
AID - 10.1378/chest.08-1382 [doi]
PST - ppublish
SO  - Chest. 2008 Nov;134(5):947-954. doi: 10.1378/chest.08-1382. Epub 2008 Aug 27.