Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands.
Respir Med. 2012 Jun;106(6):905-8. doi: 10.1016/j.rmed.2012.02.008. Epub 2012 Mar 6.
In community-acquired pneumonia (CAP), the cortisol level on admission can be a useful biomarker for prognosis. Serial cortisol measurements during the clinical course of disease and their association with disease outcome have never been reported. Furthermore, the time to recovery of the hypothalamic-pituitary-adrenal axis after a short course of dexamethasone during infection is unclear. We analyzed data from 270 hospitalized patients with CAP. Total serum cortisol was measured on presentation, day 1, 2, 4, and on control visit (day 30). Intensive care unit (ICU) admission and mortality were assessed. Additionally, to study the influence of dexamethasone on the kinetics of the cortisol response, we analyzed serial cortisol values of 43 patients treated with a four-day regimen of dexamethasone 5 mg. During hospital stay, 26/270 patients (9.6%) were admitted to the ICU and 15/270 patients (5.6%) died. Compared to patients with an uneventful recovery, cortisol on presentation was significantly higher in patients with an adverse outcome (360 μg/L, IQR 209-597 vs. 238 μg/L, IQR 151-374) (p:0.01), and also remained significantly higher throughout the course of disease. Dexamethasone treatment resulted in nearly complete suppression of the endogenous cortisol production after the first dose, but cortisol production was fully recovered on control visit. In conclusion, we showed that an adverse outcome of CAP was associated with persisting higher total serum cortisol throughout the course of disease. Delta-cortisol could be another meaningful biomarker in CAP. Next, our data indicate that a four-day dexamethasone regimen during CAP does not lead to prolonged secondary adrenal insufficiency.
在社区获得性肺炎（CAP）中，入院时的皮质醇水平可以作为预后的有用生物标志物。疾病过程中的皮质醇连续测量及其与疾病结局的关系尚未报道。此外，感染期间短期给予地塞米松后下丘脑-垂体-肾上腺轴恢复的时间尚不清楚。我们分析了 270 例住院 CAP 患者的数据。入院时、第 1 天、第 2 天、第 4 天和对照就诊（第 30 天）测量总血清皮质醇。评估重症监护病房（ICU）入院和死亡率。此外，为了研究地塞米松对皮质醇反应动力学的影响，我们分析了 43 例接受为期四天地塞米松 5mg 治疗方案的患者的连续皮质醇值。住院期间，270 例患者中有 26 例（9.6%）入住 ICU，15 例（5.6%）死亡。与无不良后果的患者相比，不良后果患者的入院时皮质醇明显更高（360μg/L，IQR 209-597 比 238μg/L，IQR 151-374）（p：0.01），并且在整个病程中仍明显升高。地塞米松治疗后，第一剂后几乎完全抑制了内源性皮质醇的产生，但在对照就诊时皮质醇的产生完全恢复。总之，我们表明 CAP 的不良结局与整个病程中持续较高的总血清皮质醇有关。Delta-皮质醇可能是 CAP 的另一个有意义的生物标志物。下一步，我们的数据表明，CAP 期间的四天地塞米松方案不会导致继发性肾上腺功能不全延长。
