Cortisol levels and adrenal response in severe community-acquired pneumonia: A systematic review of the literature
Cortisol levels and adrenal response in severe community-acquired pneumonia: A systematic review of the literature
Data
2010
Autores
Salluh, Jorge I.F.
Shinotsuka, Cássia Righy
Soares, Márcio
Bozza, Fernando A.
Silva, José Roberto Lapa e
Tura, Bernardo Rangel
Bozza, Patrícia T.
Vidal, Carolina Garcia
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of Critical Care
Resumo
Objectives: Our aim was to review the literature on the prevalence and impact of critical-illness related
corticosteroid insufficiency (CIRCI) on the outcomes of patients with severe community-acquired
pneumonia (CAP).
Methods: We reviewed Cochrane, Medline, and CINAHL databases (through July 2008) to identify
studies evaluating the adrenal function in severe CAP. Main data collected were prevalence of CIRCI
and its mortality.
Results: We screened 152 articles and identified 7 valid studies. Evaluation of adrenal function varied,
and most studies used baseline total cortisol levels. The prevalence of CIRCI in severe CAP ranged from
0% to 48%. Among 533 patients, 56 (10.7%) had cortisol levels of 10 μg/dL or less and 121 patients
(21.2%) had cortisol levels of 15 μg/dL or less. In a raw analysis, there was no significant difference in
mortality when patients with cortisol levels less than 10 μg/dL (8.6 vs 15.5%; P = .55) or less than
15 μg/dL (12.4 vs 16%; P = .38) were compared with those with cortisol above these levels. In the
meta-analysis, relative risk for mortality were 0.81 (confidence interval, 0.39-1.7; P = .59; χ2 = 1.04) for cortisol levels less than 10 μg/dL and relative risk was 0.67 (confidence interval, 0.4-1.14; P = .84;
χ2 = 1.4) for cortisol levels less than 15 μg/dL.
Conclusions: A significant proportion of patients with severe CAP fulfilled criteria for CIRCI. However,
CIRCI does not seem to affect the outcomes. Noteworthy, the presence of elevated cortisol levels is
associated with increased mortality and may be useful as a prognostic marker in patients with severe CAP.
Description
Palavras-chave
Cortisol, Corticosteroids, Community-acquired pneumonia, Adrenal failure, Sepsis
Citação
Salluh JI, Shinotsuka CR, Soares M, Bozza FA, Lapa e Silva JR, Tura BR, Bozza PT, Vidal CG. Cortisol levels and adrenal response in severe community-acquired pneumonia: a systematic review of the literature. J Crit Care. 2010 Sep;25(3):541.e1-8. doi: 10.1016/j.jcrc.2010.03.004. PMID: 20627449.