Abstract
Introduction
The serum total cortisol is a biomarker to adrenal response in stressful conditions including infection. This study aims to estimate the serum total cortisol level in severe community-acquired pneumonia (CAP) and to study its relation to the severity of illness.
Patients and methods
The study included 50 patients, who with severe CAP were admitted to the ICU of National Institute of Chest Diseases (Embaba), and 20 healthy adults as the control. Ethical approval done by ASU ethical approval team as the paper was taken from masters thesis. The severity of CAP was estimated using pneumonia severity index (PSI) and CURB65 scores. The two groups were subjected to the estimation of serum total cortisol level (8 a.m.) by electrochemiluminescence immunoassay.
Results
Serum total cortisol level significantly increased in the patient group than in the control group (20.356±11.198 and 15.070±1.384 μg/dl, respectively). Serum total cortisol level was positively correlated with PSI but not with CURB65 score.
Conclusion
Severe CAP is associated with increased serum total cortisol level compared to normal. Serum total cortisol level was positively correlated with the disease severity as estimated by PSI.
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References
Niederman MS. Recent advances in community-acquired pneumonia: inpatient and outpatient. Chest 2007; 131: 1205–1215.
Keh D, Boehnke T, Weber-Cartens S, Schulz C, Ahlers O, Bercker S, et al. Immunologic and hemodynamic effects of ‘low-dose’ hydrocortisone in septic shock: a double-blind, randomized, placebo-controlled, crossover study. Am J Respir Crit Care Med 2003; 167: 512–520.
Marik PE, Pastores SM, Anane D, Meduri GU, Sprung CL, Arlt W. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American college of Critical Care Medicine. Crit Care Med 2008; 36: 1937–1949.
Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58: 377–382.
Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997; 336: 243–250.
Kudielka BM, Buske-Kirschbaum A, Hellhammer DH, Kirschbaum C. HPA axis responses to laboratory psychosocial stress in healthy elderly adults, younger adults, and children: impact of age and gender. Psychoneuroendocrinology 2004; 29: 83–98.
Salluh JIF, Shinotsuka CR, Soares M, Bozza FA, Lapa e Silva JR, Tura BR, et al. Cortisol levels and adrenal response in severe community-acquired pneumonia: a systematic review of the literature. Journal of Critical Care 2010; 25: 541.e1–541.e8.
Fouda OM, Elatar SL. The association of serum total cortisol and pneumonia severity index. Saudi Med J 2010; 31: 887–890.
Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44: S27–S72.
Mueller C, Blum CA, Trummler M, Stolz D, Bingisser R, Mueller C, et al. Association of adrenal function and disease severity in community acquired pneumonia. PloS One 2014; 9: e 99518.
Cooper MS, Stewart PM. Corticosteroid insufficiency in acutely ill patients. N Engl J Med 2003; 348: 727–734.
Charles PG, Wolfe R, Whitby M, Fine MJ, Fuller AJ. Australian Community Acquired Pneumonia Study Collaboration, et al... SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis 2008; 47: 375–384.
Mongardon N, Max A, Bouglé A, Pène F, Lemiale V, Charpentier J, et al. Epidemiology and outcome of severe pneumococcal pneumonia admitted to intensive care unit: a multicenter study. Crit Care 2012; 16: R155.
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Khalil, M.M., Maher, M.M., Abd Al-Kader, M.A. et al. The association between the serum total cortisol as an adrenal response biomarker and severe community-acquired pneumonia. Egypt J Bronchol 13, 100 (2019). https://doi.org/10.4103/ejb.ejb_84_17
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DOI: https://doi.org/10.4103/ejb.ejb_84_17