title: Association of adrenal function and disease severity in community-acquired pneumonia.
abstract: BACKGROUND
  Rapid and accurate risk stratification in patients with community-acquired pneumonia (CAP) is an unmet clinical need. Cortisol to dehydroepiandrosterone (DHEA) ratio was put forward as a prognostic marker in sepsis. We herein validated the prognostic value of the adrenal hormones DHEA, DHEA-Sulfate (DHEAS), cortisol/DHEA-, cortisol/DHEAS- and DHEA/DHEAS-ratios in patients with CAP.
  
  
  METHODS
  We assessed severity of illness using the pneumonia severity index (PSI) and measured adrenal hormone concentrations in 179 serum samples of prospectively recruited patients hospitalized with CAP. We calculated spearman rank correlation, logistic regression analysis and Kaplan Meier curves to study associations of adrenal hormones and outcomes.
  
  
  RESULTS
  There was a significant correlation between PSI score and total cortisol (r = 0.24, p = 0.001), DHEAS (r = -0.23, p = 0.002), cortisol/DHEA (r = 0.23, p = 0.003), cortisol/DHEAS (r = 0.32, p = <0.0001) and DHEA/DHEAS (r = 0.20, p = 0.009). In age and gender adjusted logistic regression analysis, cortisol (OR:2.8, 95% CI: 1.48-5.28) and DHEA (OR: 2.62,95% CI: 1.28-5.34), but not DHEAS and the different ratios were associated with all-cause mortality. The discriminatory accuracy of cortisol and DHEA in ROC analysis (area under the curve) was 0.74 and 0.61. In Kaplan Meier analysis, patients in the highest deciles of cortisol and DHEA (p = 0.005 and p = 0.015), and to a lesser extent of cortisol/DHEAS ratio (p = 0.081) had a higher risk of death.
  
  
  CONCLUSIONS
  Cortisol, DHEAS and their ratios correlate with CAP severity, and cortisol and DHEA predict mortality. Adrenal function in severe pneumonia may be an important factor for CAP outcomes.
authors.affiliation: Department of Endocrinology, Diabetology and Metabolism, UniversityHospital, Basel, Switzerland.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Mueller
authors.affiliation: Department of Endocrinology, Diabetology and Metabolism, UniversityHospital, Basel, Switzerland.
authors.forename: Claudine A
authors.initials: CA
authors.lastname: Blum
authors.affiliation: Bioanalytica AG, Luzern, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Trummler
authors.affiliation: Department of Pneumology, University Hospital, Basel, Switzerland.
authors.forename: Daiana
authors.initials: D
authors.lastname: Stolz
authors.affiliation: Department of Emergency Medicine, University Hospital, Basel, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Bingisser
authors.affiliation: Department of Internal Medicine, University Hospital, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.affiliation: Department of Pneumology, University Hospital, Basel, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Tamm
authors.affiliation: Department of Endocrinology, Medical University Clinic, CantonalHospital, Aarau, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Mueller
authors.affiliation: Department of Endocrinology, Medical University Clinic, CantonalHospital, Aarau, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuetz
authors.affiliation: Department of Endocrinology, Diabetology and Metabolism, UniversityHospital, Basel, Switzerland.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Christ-Crain
mesh_terms: D000311:Adrenal Glands / Q000378:metabolism*; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism* / Q000401:mortality; D003687:Dehydroepiandrosterone / Q000097:blood / Q000378:metabolism; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood / Q000378:metabolism; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011014:Pneumonia / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism* / Q000401:mortality; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index
chemical_list: D003687:Dehydroepiandrosterone; D019314:Dehydroepiandrosterone Sulfate; D006854:Hydrocortisone