Association of adrenal function and disease severity in community-acquired pneumonia

Abstract

Introduction: Rapid and accurate risk stratification in patients with community-acquiredpneumonia (CAP) is an unmet clinical need. Cortisol to dehydroepiandrosterone (DHEA)ratio was put forward as a prognostic marker in sepsis. We herein validatedthe prognostic value of the adrenal hormones DHEA, DHEA-Sulfate (DHEAS),cortisol/DHEA-, cortisol/DHEAS- and DHEA/DHEAS -ratios in patients with CAP. Methods: We assessed severity of illness using the pneumonia severityindex (PSI) and measured adrenal hormone concentrations in 179 serumsamples of prospectively recruited patients hospitalized with CAP. We calculatedspearman rank correlation, logistic regression analysis and Kaplan Meier curvesto study associations of adrenal hormones and outcomes. Results: There was a significant correlation between PSI score and totalcortisol (r = 0.24, p = 0.001),DHEAS (r = -0.23, p = 0.002),cortisol/DHEA (r = 0.23, p = 0.003),cortisol/DHEAS (r = 0.32, p = <0.0001)and DHEA/DHEAS (r = 0.20, p = 0.009).In age and gender adjusted logistic regression analysis, cortisol (OR:2.8, 95% CI: 1.48-5.28) and DHEA (OR: 2.62,95% CI: 1.28-5.34), but not DHEAS and the differentratios were associated with all-cause mortality. The discriminatoryaccuracy of cortisol and DHEA in ROC analysis (area under the curve)was 0.74 and 0.61. In Kaplan Meier analysis, patients in the highest decilesof cortisol and DHEA (p = 0.005 and p = 0.015), and toa lesser extent of cortisol/DHEAS ratio (p = 0.081) hada higher risk of death. Conclusion: Cortisol, DHEAS and their ratios correlate with CAP severity,and cortisol and DHEA predict mortality. Adrenal function in severe pneumoniamay be an important factor for CAP outcomes. © 2014 Mueller et al.