Document Detail

Cortisol levels and adrenal response in severe community-acquired pneumonia: a systematic review of the literature.
MedLine Citation:
PMID:  20627449     Owner:  NLM     Status:  MEDLINE    
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; χ(2) = 1.04) for cortisol levels less than 10 μg/dL and relative risk was 0.67 (confidence interval, 0.4-1.14; P = .84; χ(2) = 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.
Jorge I F Salluh; Cássia Righy Shinotsuka; Márcio Soares; Fernando A Bozza; José Roberto Lapa e Silva; Bernardo Rangel Tura; Patrícia T Bozza; Carolina Garcia Vidal
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  Journal of critical care     Volume:  25     ISSN:  1557-8615     ISO Abbreviation:  J Crit Care     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-14     Completed Date:  2010-12-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8610642     Medline TA:  J Crit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  541.e1-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
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MeSH Terms
Adrenal Glands / physiopathology*
Adrenal Insufficiency / epidemiology
Community-Acquired Infections / blood,  mortality,  physiopathology
Critical Illness
Hydrocortisone / blood*
Pneumonia / blood*,  mortality,  physiopathology*
Severity of Illness Index
Reg. No./Substance:

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