Time-dependent association of glucocorticoids with adverse outcome in community-acquired pneumonia: a 6-year prospective cohort study

Mar 25, 2017Critical care (London, England)

Changes over time in stress hormone levels linked to worse outcomes in community-acquired pneumonia

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Abstract

Mortality was 5.3% after 30 days and increased to 47.3% after 6 years in a cohort of 285 patients with community-acquired pneumonia.

High admission cortisol levels were associated with a greater risk of adverse outcomes shortly after hospitalization.
After 30 days, the odds of mortality were 3.85 times higher for patients with elevated cortisol levels.
In the long term, higher cortisol levels were linked to improved survival rates, with a 43% reduction in the risk of death after 3 years.
Cortisol demonstrated a stronger association with mortality compared to 11-deoxycortisol, cortisone, and corticosterone.
These findings suggest that the glucocorticoid stress response at hospital admission has differing implications for short- and long-term outcomes.

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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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Time-dependent association of glucocorticoids with adverse outcome in community-acquired pneumonia: a 6-year prospective cohort study

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