Cortisol levels in patients with severe community-acquired pneumonia.

OBJECTIVES

To evaluate cortisol levels and prevalence of adrenal insufficiency in patients with severe community-acquired pneumonia (CAP).

DESIGN AND SETTING

Retrospective cohort study in a 24-bed medical-surgical intensive care unit (ICU).

PATIENTS

Forty patients with severe CAP admitted to the ICU from March 2003 and May 2005.

MEASUREMENTS AND RESULTS

Random cortisol levels were measured up to 72 h after ICU admission. A threshold of 20 microg/dl was considered for the diagnosis of adrenal insufficiency. Median cortisol levels were 15.5 microg/dl (IQR 10.8-25.1), and 26 patients (65%) met the criteria for adrenal insufficiency. Other cutoff levels of cortisol were evaluated, and 30 patients (75%) had cortisol levels below 25 microg/dl and 19 (47.5%) had cortisol levels below 15 microg/dl. When only patients with septic shock (n=19) were evaluated, 12 (63%) had adrenal insufficiency.

CONCLUSIONS

Relative adrenal insufficiency occurs in a high proportion of patients with severe CAP. This finding highlights the importance of measuring cortisol levels and may help explain the potential benefits of hydrocortisone infusion in these patients.