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

Abstract

BackgroundThe 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.MethodsWe 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.ResultsMortality 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.ConclusionsAmong 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1656-7) contains supplementary material, which is available to authorized users.

Association of Taurine with In-Hospital Mortality in Patients after Out-of-Hospital Cardiac Arrest: Results from the Prospective, Observational COMMUNICATE Study

“…Blood samples of all enrolled patients were taken for routine testing with tube type BD Vacutainer Serum SST II Advance. Additionally, further serum aliquots were frozen at −80 • C and stored until tested for metabolomic markers [24][25][26][27]. As secondary tubes, conical false bottom tubes made of polyethylene with a lamellar plug were used.…”

Dihydrotestosterone is a predictor for mortality in males with community-acquired pneumonia: results of a 6-year follow-up study

“…In addition, initial high serum levels of 17-OH-progesterone were associated with significant better long-term survival in males and in the entire cohort. 17-OH-progesterone is a precursor of the stress hormone cortisol; thus, it is likely that higher serum levels of 17-OH-progesterone reflect a more pronounced stress response with cortisol production, which has already been shown to be beneficial regarding long-term survival in CAP patients [ 8 ].We did not find these associations of dihydrotestosterone or 17-OH-progesterone with long-term mortality in females. The female population was significantly younger, had a longer life expectancy and 6-year mortality was significantly lower (38%) than in the male population (53%).…”

“…Consecutively, the adrenal gland produces a variety of glucocorticoid, mineralocorticoid and sexual hormones. Different studies have shown a correlation of cortisol levels with severity, short- and long-term outcome in CAP and sepsis [ 3 – 8 ]. An independent association of aldosterone levels with survival-time in septic shock in canine bacterial sepsis has also been shown [ 6 ].…”

Low Plasma Sphingomyelin Levels Show a Weak Association with Poor Neurological Outcome in Cardiac Arrest Patients: Results from the Prospective, Observational COMMUNICATE Trial

“…Upon admission to the ICU, blood samples from each patient were drawn for routine chemistry measurements and additionally, serum samples were aliquoted and frozen at −80 • C until retesting for the measurement of metabolomics biomarkers [23][24][25][26]. As secondary tubes, conical false bottom tubes made of polyethylene with a lamellar plug were used.…”