Serum Estradiol Level at Intensive Care Unit Admission and Mortality in Critically Ill Patients

Abstract

Context:It has been observed that sex hormones may play a role in inflammatory processes and mortality of critically ill patients.Aims:The aim was evaluated the relationship between serum estradiol level at Intensive Care Unit (ICU) admission and mortality of critically ill patients.Settings and Design:This study was a prospective cohort conducted in one mixed ICU.Subjects and Methods:In heterogeneous group of critically ill patients admitted to the ICU, we measured serum estradiol at admission time.Statistical Analysis Used:The discrimination to predict mortality of serum estradiol level was assessed by the receiver-operating curve (ROC) curve and its association with mortality by logistic regression analysis.Results:We included 131 patients, 57.3% of which were male. The serum estradiol level measured at ICU admission was significantly higher in nonsurvivors than in survivors: 116 versus 67.2 pg/mL, respectively (P < 0.0001). The area under the ROC of serum estradiol level to predict mortality was 0.74 (P < 0.0001). Serum estradiol level ≥97.9 pg/mL had sensitivity of 60%, specificity of 90%, positive predictive value of 64%, negative predictive value of 88%, positive likelihood ratio of 6, and negative likelihood ratio of 0.44, for predicting mortality. In multivariate analysis, it had relative risk of 6.47 (P = 0.002) for ICU mortality.Conclusions:The serum estradiol level is elevated in critically ill patients, regardless of gender, especially in those who die. It has good discriminative capacity to predict mortality, and it is an independent risk factor for death in this group of patients.

The role of estradiol in the immune response against COVID-19

“…This hormone is inhibited by class I cytokines and TNF alpha during stress. However, its peripheral production by enzyme aromatase in adipose tissue is activated regardless of gender [ 73 ]. Estradiol levels were measured in critically ill patients before management in intensive care units (ICUs), and the differences were remarkable between survivors and non-survivors ( p < 0.01) in whom the mean levels of estradiol were 62.2 versus 116 pg/mL, respectively [ 73 ].…”

“…However, its peripheral production by enzyme aromatase in adipose tissue is activated regardless of gender [ 73 ]. Estradiol levels were measured in critically ill patients before management in intensive care units (ICUs), and the differences were remarkable between survivors and non-survivors ( p < 0.01) in whom the mean levels of estradiol were 62.2 versus 116 pg/mL, respectively [ 73 ]. Another study from 2011 reported that high estradiol levels for ICU admission were associated with high mortality in a cohort of 1408 critically ill patients (14.1%, 95% CI 12.3–16).…”

“…A prospective cohort study performed in ICU patients in 2008 reported that estradiol levels were significantly higher in non-survivors regardless of gender (40.7 versus 18.7 pg/mL) [ 75 ]. In general terms, scientific evidence from non-SARS-CoV-2 infected patients reveals that abnormally high estradiol levels in critically ill patients are associated with poor outcomes [ 73 – 75 ].…”

Sex Differences in the Exocrine Pancreas and Associated Diseases

“… 54 The increased risk of death with serum estradiol elevations is seen with other forms of acute injuries in both men and women. 55 , 56 Whether this is due to a direct effect of estradiol in exacerbating or ameliorating injury or it just a biomarker with no direct role in injury remains to be studied. Estrogens, but not anabolic androgen steroids, are associated with both an increased serum triglyceride levels and pancreatitis, 57 but the source of these steroid hormones remains to be determined.…”