Serum Estradiol Level at Intensive Care Unit Admission and Mortality in Critically Ill Patients

CONTEXT: It has been observed that sex hormones may play a role in inflammatory processes and mortality of critically ill patients. AIMS: The aim was evaluated the relationship between serum estradiol level at Intensive Care Unit (ICU) admission and mortality of critically ill patients. SETTINGS AND DESIGN: This study was a prospective cohort conducted in one mixed ICU. SUBJECTS AND METHODS: In heterogeneous group of critically ill patients admitted to the ICU, we measured serum estradiol at admission time. STATISTICAL ANALYSIS USED: The discrimination to predict mortality of serum estradiol level was assessed by the receiver-operating curve (ROC) curve and its association with mortality by logistic regression analysis. RESULTS: We included 131 patients, 57.3% of which were male. The serum estradiol level measured at ICU admission was significantly higher in nonsurvivors than in survivors: 116 versus 67.2 pg/mL, respectively (P < 0.0001). The area under the ROC of serum estradiol level to predict mortality was 0.74 (P < 0.0001). Serum estradiol level ≥97.9 pg/mL had sensitivity of 60%, specificity of 90%, positive predictive value of 64%, negative predictive value of 88%, positive likelihood ratio of 6, and negative likelihood ratio of 0.44, for predicting mortality. In multivariate analysis, it had relative risk of 6.47 (P = 0.002) for ICU mortality. CONCLUSIONS: The serum estradiol level is elevated in critically ill patients, regardless of gender, especially in those who die. It has good discriminative capacity to predict mortality, and it is an independent risk factor for death in this group of patients.