The online version of this article (doi:10.1186/s13054-017-1656-7) contains supplementary material, which is available to authorized users.
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.
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.
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.
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.
Additional file 1: Table S1. Baseline characteristics overall and stratified by 30-day adverse outcome, including the combined endpoint death/ICU admission in CAP. Data are presented as median [IQR] or number (percent); p values are considered statistically significant at p < 0.05. Bold values indicate statistical significance. CAP, Community-acquired pneumonia; CRP, C-reactive protein; CURB65, Confusion of new onset, blood urea nitrogen >7 mmol/L, respiratory rate ≥30 breaths per minute, systolic blood pressure <90 mmHg or diastolic blood pressure ≤60, and age ≥65 years; ICU, Intensive care unit; PAOD, Peripheral arterial occlusive disease; PCT, Procalcitonin; PSI, Pneumonia severity index; SBP, Systolic blood pressure; SIRS, Systemic inflammatory response syndrome. *Comorbidities were identified on the basis of medical records or patient report. (DOCX 21 kb)13054_2017_1656_MOESM1_ESM.docx
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- Time-dependent association of glucocorticoids with adverse outcome in community-acquired pneumonia: a 6-year prospective cohort study
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