title: Serum cortisol and inflammatory response in neutropenic fever.
abstract: There are no data on serum cortisol of hematological patients at the onset of neutropenic fever and its possible association with the severity of infection. The purpose of this study was to evaluate the association of serum cortisol with the level of C-reactive protein (CRP) and procalcitonin (PCT), widely used markers of infection and inflammation, and with the development of severe sepsis in this patient group. All clinical data were collected prospectively at the hematology ward of Kuopio University Hospital. Altogether, 69 hematological patients with 93 periods of neutropenic fever were included. Nineteen patients received therapy for acute myeloid leukemia, and 50 patients were autologous stem cell transplantation recipients. Each period of neutropenic fever was classified as severe sepsis or not. Serum cortisol, CRP, and PCT were determined at the onset of fever on day 0 and then at 8-9 a.m. on days 1-4. Level of serum cortisol correlated positively with maximal CRP level during days 0 to 4 in neutropenic fever periods without severe sepsis, but no correlation was observed in fever periods with severe sepsis. To conclude, the level of cortisol correlated with the severity of infection measured as maximal CRP or elevated PCT in fever periods without severe sepsis, but in fever periods with severe sepsis, the cortisol response was attenuated.
authors: Institute of Clinical Medicine/Internal Medicine, University of Eastern Finland, P.O.B. 1777, 70211, Kuopio, Finland. auni.juutilainen@kuh.fi
authors: Auni
authors: A
authors: Juutilainen
authors: Sari
authors: S
authors: Hämäläinen
authors: Juuso
authors: J
authors: Niemenpää
authors: Taru
authors: T
authors: Kuittinen
authors: Kari
authors: K
authors: Pulkki
authors: Irma
authors: I
authors: Koivula
authors: Leo
authors: L
authors: Niskanen
authors: Esa
authors: E
authors: Jantunen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D005334:Fever / Q000097:blood* / Q000209:etiology* / Q000276:immunology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007249:Inflammation / Q000209:etiology* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000097:blood* / Q000150:complications* / Q000276:immunology; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D018805:Sepsis / Q000097:blood / Q000150:complications / Q000276:immunology; D055815:Young Adult
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide; D006854:Hydrocortisone