title: Relationship between alcohol use disorders, cortisol concentrations, and cytokine levels in patients with sepsis.
abstract: BACKGROUND
  Patients with alcohol use disorders (AUD) are at increased risk of developing sepsis and have higher mortality. AUD are associated with higher cortisol and anti-inflammatory cytokine profile. Higher cortisol increases risk of death in septic patients. The relationship between AUD and cortisol in septic patients is unknown. We aimed to study this relationship and postulated that AUD would be associated with higher cortisol and anti-inflammatory cytokine profile.
  
  
  METHODS
  This was a prospective cohort study of 40 medical intensive care unit (ICU) patients admitted with sepsis. Cortisol, anti-inflammatory interleukin (IL) 10, and pro-inflammatory IL1β, IL6, tumor necrosis factor (TNF) α were measured.
  
  
  RESULTS
  Thirteen (32%) out of 40 patients had AUD. AUD patients had higher cortisol by univariate (39 microg/dl versus 24, P = 0.04) and multivariable analyses (44 microg/dl versus 23, P = 0.004). By univariate analyses, AUD patients had higher IL10 (198 picog/dl versus 47, P = 0.02) and IL6 (527 picog/ml versus 156, P = 0.048), but similar IL1β and TNFα. By multivariable analyses, AUD patients had higher IL10 (182 picog/dl versus 23, P = 0.049) but similar IL1β, IL6, and TNFα. AUD patients had lower IL1β/IL10 (univariate 0.01 versus 0.10, P = 0.04; multivariable 0.01 versus 0.03, P = 0.04), lower TNFα/IL10 (univariate 0.15 versus 0.52, P = 0.03; multivariable 0.11 versus 0.63, P = 0.01), but similar IL6/IL10.
  
  
  CONCLUSIONS
  AUD are common diagnoses among medical ICU patients with sepsis. Patients with AUD have higher cortisol concentrations and have differences in cytokine expression. Future studies should seek to determine if these differences may explain the higher severity of illness seen in patients with sepsis and AUD.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT00615862.
authors.affiliation: Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA 23298-0050, USA. mdewit@mcvh-vcu.edu
authors.forename: Marjolein
authors.initials: M
authors.lastname: de Wit
authors.forename: Gregory K
authors.initials: GK
authors.lastname: Wiaterek
authors.forename: Nicole D
authors.initials: ND
authors.lastname: Gray
authors.forename: Keith E
authors.initials: KE
authors.lastname: Goulet
authors.forename: Al M
authors.initials: AM
authors.lastname: Best
authors.forename: John N
authors.initials: JN
authors.lastname: Clore
authors.forename: Lori B
authors.initials: LB
authors.lastname: Sweeney
mesh_terms: D018806:APACHE; D000328:Adult; D019973:Alcohol-Related Disorders / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D015415:Biomarkers / Q000378:metabolism; D015331:Cohort Studies; D016207:Cytokines / Q000378:metabolism*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism
chemical_list: D015415:Biomarkers; D016207:Cytokines; D006854:Hydrocortisone