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Time-dependent association of glucocorticoids with adverse outcome in community-acquired pneumonia: a 6-year prospective cohort study

BACKGROUND: The hypothalamic-pituitary-adrenal stress axis plays a crucial role in community-acquired pneumonia (CAP), with high cortisol being associated with disease severity and corticosteroid treatment resulting in earlier time to recovery. Our aim in the present study was to compare different g...

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Autores principales: Nickler, Manuela, Ottiger, Manuel, Steuer, Christian, Kutz, Alexander, Christ-Crain, Mirjam, Zimmerli, Werner, Thomann, Robert, Hoess, Claus, Henzen, Christoph, Bernasconi, Luca, Huber, Andreas, Mueller, Beat, Schuetz, Philipp
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364618/
https://www.ncbi.nlm.nih.gov/pubmed/28335807
http://dx.doi.org/10.1186/s13054-017-1656-7
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author Nickler, Manuela
Ottiger, Manuel
Steuer, Christian
Kutz, Alexander
Christ-Crain, Mirjam
Zimmerli, Werner
Thomann, Robert
Hoess, Claus
Henzen, Christoph
Bernasconi, Luca
Huber, Andreas
Mueller, Beat
Schuetz, Philipp
author_facet Nickler, Manuela
Ottiger, Manuel
Steuer, Christian
Kutz, Alexander
Christ-Crain, Mirjam
Zimmerli, Werner
Thomann, Robert
Hoess, Claus
Henzen, Christoph
Bernasconi, Luca
Huber, Andreas
Mueller, Beat
Schuetz, Philipp
author_sort Nickler, Manuela
collection PubMed
description BACKGROUND: The hypothalamic-pituitary-adrenal stress axis plays a crucial role in community-acquired pneumonia (CAP), with high cortisol being associated with disease severity and corticosteroid treatment resulting in earlier time to recovery. Our aim in the present study was to compare different glucocorticoid hormones, including cortisol, 11-deoxycortisol, cortisone, and corticosterone, regarding their association with short- and long-term adverse outcomes in a well-defined CAP cohort. METHODS: We prospectively followed 285 patients with CAP from a previous Swiss multicenter trial for a median of 6.1 years and measured different admission glucocorticoid serum levels by liquid chromatography coupled with tandem mass spectrometry. We used adjusted Cox regression models to investigate associations between admission hormone levels and all-cause mortality at different time points. RESULTS: Mortality was 5.3% after 30 days and increased to 47.3% after 6 years. High admission cortisol was associated with adverse outcome after 30 days (adjusted OR 3.85, 95% CI 1.10–13.49, p = 0.035). In the long term (i.e.,), however, high admission cortisol was associated with better survival (adjusted HR after 3 years 0.53, 95% CI 0.32–0.89, p = 0.017; adjusted HR after 6 years 0.57, 95% CI 0.36–0.90, p = 0.015). Compared with 11-deoxycortisol, cortisone, and corticosterone, cortisol showed the highest association with mortality. CONCLUSIONS: Among different glucocorticoid hormones, cortisol showed the highest association with mortality in CAP. Whereas a more pronounced glucocorticoid stress response on hospital admission was associated with higher short-term adverse outcome, long-term outcome was favorable in these patients. These data should support the correct interpretation of glucocorticoid blood data. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-017-1656-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-53646182017-03-24 Time-dependent association of glucocorticoids with adverse outcome in community-acquired pneumonia: a 6-year prospective cohort study Nickler, Manuela Ottiger, Manuel Steuer, Christian Kutz, Alexander Christ-Crain, Mirjam Zimmerli, Werner Thomann, Robert Hoess, Claus Henzen, Christoph Bernasconi, Luca Huber, Andreas Mueller, Beat Schuetz, Philipp Crit Care Research BACKGROUND: The hypothalamic-pituitary-adrenal stress axis plays a crucial role in community-acquired pneumonia (CAP), with high cortisol being associated with disease severity and corticosteroid treatment resulting in earlier time to recovery. Our aim in the present study was to compare different glucocorticoid hormones, including cortisol, 11-deoxycortisol, cortisone, and corticosterone, regarding their association with short- and long-term adverse outcomes in a well-defined CAP cohort. METHODS: We prospectively followed 285 patients with CAP from a previous Swiss multicenter trial for a median of 6.1 years and measured different admission glucocorticoid serum levels by liquid chromatography coupled with tandem mass spectrometry. We used adjusted Cox regression models to investigate associations between admission hormone levels and all-cause mortality at different time points. RESULTS: Mortality was 5.3% after 30 days and increased to 47.3% after 6 years. High admission cortisol was associated with adverse outcome after 30 days (adjusted OR 3.85, 95% CI 1.10–13.49, p = 0.035). In the long term (i.e.,), however, high admission cortisol was associated with better survival (adjusted HR after 3 years 0.53, 95% CI 0.32–0.89, p = 0.017; adjusted HR after 6 years 0.57, 95% CI 0.36–0.90, p = 0.015). Compared with 11-deoxycortisol, cortisone, and corticosterone, cortisol showed the highest association with mortality. CONCLUSIONS: Among different glucocorticoid hormones, cortisol showed the highest association with mortality in CAP. Whereas a more pronounced glucocorticoid stress response on hospital admission was associated with higher short-term adverse outcome, long-term outcome was favorable in these patients. These data should support the correct interpretation of glucocorticoid blood data. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-017-1656-7) contains supplementary material, which is available to authorized users. BioMed Central 2017-03-24 /pmc/articles/PMC5364618/ /pubmed/28335807 http://dx.doi.org/10.1186/s13054-017-1656-7 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Nickler, Manuela
Ottiger, Manuel
Steuer, Christian
Kutz, Alexander
Christ-Crain, Mirjam
Zimmerli, Werner
Thomann, Robert
Hoess, Claus
Henzen, Christoph
Bernasconi, Luca
Huber, Andreas
Mueller, Beat
Schuetz, Philipp
Time-dependent association of glucocorticoids with adverse outcome in community-acquired pneumonia: a 6-year prospective cohort study
title Time-dependent association of glucocorticoids with adverse outcome in community-acquired pneumonia: a 6-year prospective cohort study
title_full Time-dependent association of glucocorticoids with adverse outcome in community-acquired pneumonia: a 6-year prospective cohort study
title_fullStr Time-dependent association of glucocorticoids with adverse outcome in community-acquired pneumonia: a 6-year prospective cohort study
title_full_unstemmed Time-dependent association of glucocorticoids with adverse outcome in community-acquired pneumonia: a 6-year prospective cohort study
title_short Time-dependent association of glucocorticoids with adverse outcome in community-acquired pneumonia: a 6-year prospective cohort study
title_sort time-dependent association of glucocorticoids with adverse outcome in community-acquired pneumonia: a 6-year prospective cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364618/
https://www.ncbi.nlm.nih.gov/pubmed/28335807
http://dx.doi.org/10.1186/s13054-017-1656-7
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