Cortisol levels in patients with severe community-acquired pneumonia.
OBJECTIVE
To evaluate cortisol levels and prevalence of adrenal insufficiency in patients with severe community-acquired pneumonia (CAP).


METHODS
Retrospective cohort study in a 24-bed medical-surgical intensive care unit (ICU).


METHODS
Forty patients with severe CAP admitted to the ICU from March 2003 and May 2005.


RESULTS
Random cortisol levels were measured up to 72 h after ICU admission. A threshold of 20 microg/dl was considered for the diagnosis of adrenal insufficiency. Median cortisol levels were 15.5 microg/dl (IQR 10.8-25.1), and 26 patients (65%) met the criteria for adrenal insufficiency. Other cutoff levels of cortisol were evaluated, and 30 patients (75%) had cortisol levels below 25 microg/dl and 19 (47.5%) had cortisol levels below 15 microg/dl. When only patients with septic shock (n=19) were evaluated, 12 (63%) had adrenal insufficiency.


CONCLUSIONS
Relative adrenal insufficiency occurs in a high proportion of patients with severe CAP. This finding highlights the importance of measuring cortisol levels and may help explain the potential benefits of hydrocortisone infusion in these patients.
Medical-Surgical Intensive Care Unit, Instituto Nacional de Câncer, Centro de Tratamento Intensivo, Andar Rio de Janeiro, Brazil. jorgesalluh@yahoo.com.br
Jorge I F
JI
Salluh
Juan C
JC
Verdeal
Gustavo W
GW
Mello
Leonardo V
LV
Araújo
Gloria A R
GA
Martins
Marcelo
M
de Sousa Santino
Márcio
M
Soares
D000309:Adrenal Insufficiency / Q000453:epidemiology* / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000150:complications*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis* / Q000097:blood; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000503:physiopathology*; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications; D012720:Severity of Illness Index
D006854:Hydrocortisone