Background
Methods
Study design
Study population
Steroid hormone analysis
Main outcome measurements
Statistical analysis
Results
Characteristics of the study population
Characteristics | Entire cohort (N = 285) | MALE (N = 172) | FEMALE (N = 113) | ||||
---|---|---|---|---|---|---|---|
6-year vital status | |||||||
Survivors (n = 80) | Non-survivors (n = 92) |
P value
| Survivors (n = 70) | Non-survivors (n = 43) | p value | ||
Demographics
| |||||||
Age | 71 [57, 81] | 65 [46.5, 74.5] | 78 [70, 84] |
< 0.001
| 62 [43, 75] | 79 [72, 85] |
< 0.001
|
Male | 172 (60.4%) | ||||||
CAP characteristics
| |||||||
PSI class | |||||||
I | 32 (11.2%) | 12 (15%) | 0 (0%) |
< 0.001
| 18 (26%) | 2 (5%) |
0.004
|
II | 55 (19.3%) | 22 (28%) | 5 (5%) |
< 0.001
| 22 (31%) | 6 (14%) |
0.037
|
III | 52 (18.2%) | 16 (20%) | 16 (17%) | 0.66 | 13 (19%) | 7 (16%) | 0.76 |
IV | 104 (36.5%) | 23 (29%) | 45 (49%) |
0.007
| 15 (21%) | 21 (49%) |
0.002
|
V | 42 (14.7%) | 7 (9%) | 26 (28%) |
0.001
| 2 (3%) | 7 (16%) |
0.011
|
CURB-65 score | |||||||
0 | 63 (22.1%) | 24 (30%) | 6 (7%) |
< 0.001
| 27 (39%) | 6 (14%) |
0.005
|
I | 67 (23.5%) | 20 (25%) | 21 (23%) | 0.74 | 21 (30%) | 5 (12%) |
0.024
|
II | 82 (28.8%) | 22 (28%) | 29 (32%) | 0.56 | 11 (16%) | 20 (47%) |
< 0.001
|
III | 57 (20.0%) | 11 (14%) | 27 (29%) |
0.014
| 10 (14%) | 9 (21%) | 0.36 |
IV/V | 16 (5.6%) | 3 (4%) | 9 (10%) | 0.12 | 1 (1%) | 3 (7%) | 0.12 |
Comorbidities
a
| |||||||
Coronary heart disease | 59 (20.7%) | 11 (14%) | 34 (37%) |
< 0.001
| 5 (7%) | 9 (21%) |
0.031
|
Congestive heart failure | 44 (15.4%) | 4 (5%) | 25 (27%) |
< 0.001
| 3 (4%) | 12 (28%) |
< 0.001
|
Cerebrovascular insult | 28 (9.8%) | 4 (5%) | 15 (16%) |
0.018
| 5 (7%) | 4 (9%) | 0.68 |
PAOD | 17 (6.0%) | 5 (6%) | 8 (9%) | 0.55 | 2 (3%) | 2 (5%) | 0.62 |
Chronic renal failure | 67 (23.5%) | 12 (15%) | 30 (33%) |
0.007
| 7 (10%) | 18 (42%) |
< 0.001
|
Diabetes mellitus | 55 (19.3%) | 14 (18%) | 23 (25%) | 0.23 | 8 (11%) | 10 (23%) | 0.095 |
Neoplastic disease | 38 (13.3%) | 9 (11%) | 23 (25%) |
0.021
| 3 (4%) | 3 (7%) | 0.54 |
Clinical history
| |||||||
Fever | 185 (65.1%) | 68 (85%) | 48 (53%) |
< 0.001
| 45 (64%) | 24 (56%) | 0.37 |
Chills | 87 (34.0%) | 31 (42%) | 23 (29%) | 0.086 | 27 (42%) | 6 (15%) |
0.006
|
Glucocorticoid pretreatment | 22 (7.9%) | 2 (3%) | 13 (14%) |
0.008
| 3 (4%) | 4 (10%) | 0.27 |
Clinical findings
| |||||||
Confusion | 20 (7.9%) | 4 (5%) | 13 (16%) |
0.034
| 0 (0%) | 3 (8%) |
0.022
|
Body temperature, °C | 38 [37.2, 38.8] | 38.4 [37.5, 39] | 38 [37, 38.8] | 0.090 | 37.9 [37.2, 38.6] | 37.6 [36.9, 38.6] | 0.21 |
Breath rate, beaths/min. | 20 [16, 25] | 20 [16, 24] | 24 [18, 28] |
0.009
| 20 [17.00, 24.00] | 22 [17, 28] | 0.14 |
Heart rate, beats/min. | 94 [82, 105] | 92 [86, 105.5] | 95.5 [80, 105] | 0.86 | 95 [82, 109] | 93 [82, 100] | 0.28 |
SBP, mmHg | 130 [117, 148] | 130.5 [121, 150] | 128.5 [104, 150] | 0.077 | 131 [117, 145] | 133 [118, 145] | 0.96 |
Arterial pH | 7.46 [7.42, 7.49] | 7.46 [7.44, 7.49] | 7.44 [7.41, 7.48] | 0.095 | 7.46 (7.43, 7.50) | 7.45 (7.40, 7.50) | 0.11 |
qSOFA (≥ 2) | 25 (10.6%) | 2 (3%) | 18 (25%) |
< 0.001
| 0 (0%) | 5 (14%) |
0.003
|
Admission laboratory findings
| |||||||
CRP, mg/l | 132 [65, 252] | 145 [78, 240] | 110 [55, 252] | 0.17 | 148[105, 284] | 121 [62, 234] | 0.13 |
PCT, mcg/l | 0.48 [0.16, 3.20] | 0.42 [0.19, 3.56] | 0.51 [0.16, 2.60] | 0.48 | 0.72 [0.12, 5.58] | 0.32 [0.16, 1.50] | 0.52 |
Progesterone, nmol/l | 0.69 [0.44, 1.43] | 0.69 [0.46, 1.57] | 0.66 [0.37, 1.06] | 0.26 | 0.88 [0.56, 2.62] | 0.73 [0.52, 1.09] | 0.13 |
17-OH-Progesterone, nmol/l | 1.74 [0.87, 3.35] | 1.88 [1.08, 3.32] | 1.67 [0.96, 3.36] | 0.51 | 1.67 [0.54, 3.50] | 1.55 [0.63, 3.18] | 0.94 |
Aldosterone, nmol/l | 0.06 [0.03, 0.20] | 0.07 [0.04, 0.22] | 0.05 [0.03, 0.18] | 0.18 | 0.05 [0.03, 0.17] | 0.08 [0.04, 0.19] | 0.43 |
DHEA, nmol/l | 13.43 [7.73, 209.55] | 39.74 [8.8, 409.4] | 7.67 [6.27, 142.2] | 0.071 | 21.84 [9.90, 330.01] | 11.47 [6.78, 26.52] | 0.18 |
DHEA-S, nmol/l | 2280.09 [836.72, 3660.99] | 3975.42 [2837.7, 7960.95] | 1193.58 [647.62, 2559.29] |
< 0.001
| 2317.52 [1537.38, 3660.99] | 911.44 [379.14, 2506.82] | 0.081 |
Androstenedione, nmol/l | 2.78 [1.36, 4.58] | 2.86 [1.29, 4.33] | 2.33 [1.24, 4.35] | 0.44 | 3.18 [1.75, 6.24] | 2.80 [1.18, 4.78] | 0.11 |
Testosterone, nmol/l | 1.63 [0.49, 4.68] | 4.36 [1.98, 6.22] | 3.29 [2.04, 6.39] | 0.62 | 0.50 [0.29, 0.70] | 0.34 [0.24, 0.56] | 0.13 |
Dihydrotestosterone, nmol/l | 1.31 [0.26, 2.83] | 0.91 [0.22, 2.16] | 1.59 [1.07, 3.42] | 0.11 | 0.84 [0.42, 2.83] | 1.69 [0.18, 3.09] | 0.93 |
Time-dependent association between admission hormone metabolite levels and mortality
Men (N = 172) | All-cause mortality timepoint | |||||
---|---|---|---|---|---|---|
30 days | 3 years | 6 years | ||||
HR (95%CI)
|
p value
|
HR (95%CI)
|
p value
|
HR (95%CI)
|
p value
| |
Progesterone
| ||||||
Cox regression analyses | 0.66 (95%CI 0.11–3.83) | p = 0.643 | 0.66 (95%CI 0.34–1.31) | p = 0.239 | 0.69 (95%CI 0.40–1.18) | p = 0.178 |
17-OH-Progesterone
| ||||||
Cox regression analyses | 0.72 (95%CI 0.35–1.48) | p = 0.369 | 0.66 (95%CI 0.47–0.92) | p = 0.015 | 0.72 (95%CI 0.54–0.97) | p = 0.029 |
Aldosterone
| ||||||
Cox regression analyses | 1.91 (95%CI 0.55–6.63) | p = 0.310 | 1.25 (95%CI 0.74–2.12) | p = 0.410 | 0.89 (95%CI 0.59–1.33) | p = 0.565 |
DHEA
| ||||||
Cox regression analyses | 0.16 (95%CI 0.01–3.79) | p = 0.255 | 0.67 (95%CI 0.35–1.27) | p = 0.221 | ||
DHEA-S
| ||||||
Cox regression analyses | 0.57 (95%CI 0.01–25.17) | p = 0.768 | 0.69 (95%CI 0.20–2.42) | p = 0.562 | 0.55 (95%CI 0.18–1.67) | p = 0.293 |
Androstenedione
| ||||||
Cox regression analyses | 5.46 (95%CI 0.85–35.12) | p = 0.074 | 0.59 (95%CI 0.34–0.99) | p = 0.049 | 0.65 (95%CI 0.40–1.05) | p = 0.081 |
Testosterone
| ||||||
Cox regression analyses | 0.69 (95%CI 0.16–2.94) | p = 0.613 | 1.36 (95%CI 0.73–2.52) | p = 0.328 | 1.04 (95%CI 0.64–1.72) | p = 0.865 |
Dihydrotestosterone
| ||||||
Cox regression analyses | 6.08 (95%CI 0.15–254.59) | p = 0.344 | 2.0 (95%CI 0.64–6.27) | p = 0.236 | 2.84 (95%CI 1.15–6.99) | p = 0.023 |
Females (N = 113) | All-cause mortality timepoint | |||||
---|---|---|---|---|---|---|
30 days | 3 years | 6 years | ||||
HR (95%CI)
|
p value
|
HR (95%CI)
|
p value
|
HR (95%CI)
|
p value
| |
Progesterone
| ||||||
Cox regression analyses | 0.34 (95%CI 0.004–25.46) | p = 0.621 | 0.24 (95%CI 0.08–0.71) | p = 0.010 | 0.44 (95%CI 0.17–1.14) | p = 0.093 |
17-OH-Progesterone
| ||||||
Cox regression analyses | 0.55 (95%CI 0.09–3.46) | p = 0.528 | 0.99 (95%CI 0.45–2.19) | p = 0.979 | 0.98 (95%CI 0.50–1.93) | p = 0.963 |
Aldosterone
| ||||||
Cox regression analyses | 0.29 (95%CI 0.04–2.14) | p = 0.226 | 0.64 (95%CI 0.30–1.39) | p = 0.263 | 0.81 (95%CI 0.43–1.53) | p = 0.516 |
DHEA
| ||||||
Cox regression analyses | 1.98 (95%CI 0.33–11.97) | p = 0.456 | 1.44 (95%CI 0.30–6.91) | p = 0.645 | ||
DHEA-S
| ||||||
Cox regression analyses | 0.69 (95%CI 0.22–2.19) | p = 0.529 | 0.55 (95%CI 0.23–1.31) | p = 0.178 | ||
Androstenedione
| ||||||
Cox regression analyses | 1.41 (95%CI 0.31–6.38) | p = 0.652 | 1.03 (95%CI 0.58–1.83) | p = 0.925 | 1.10 (95%CI 0.68–1.79) | p = 0.695 |
Testosterone
| ||||||
Cox regression analyses | 0.92 (95%CI 0.29–2.92) | p = 0.887 | 0.81 (95%CI 0.40–1.67) | p = 0.574 | 0.91 (95%CI 0.48–1.70) | p = 0.758 |
Dihydrotestosterone
| ||||||
Cox regression analyses | 1.78 (95%CI 0.60–5.25) | p = 0.296 | 1.20 (95%CI 0.56–2.59) | p = 0.638 |