| Cortisol levels and adrenal response in severe community-acquired pneumonia: a systematic review of the literature. | |
| | |
MedLine Citation:
|
PMID: 20627449 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
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. |
| | |
Authors:
|
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 |
Related Documents
:
|
8692469 - Scintigraphic diagnosis of subclinical cushing's syndrome in patients with adrenal inci... 14705969 - Fatigue after aneurysmal subarachnoid hemorrhage evaluated by pituitary function and 3d... 10770179 - Subclinical cushing's syndrome in patients with adrenal incidentaloma: clinical and bio... 9869699 - Retroperitoneal approach in laparoscopic adrenalectomy: is it advantageous? 3491959 - Fertility rates in female patients with congenital adrenal hyperplasia due to 21-hydrox... 15937939 - Cause of sudden, unexpected death of prader-willi syndrome patients with or without gro... 21855519 - Clinical and electrocardiographic characteristics of patients with short qt interval in... 20818819 - Pathophysiological significance of gallbladder volume changes in gallstone diseases. 18204139 - Left ventricular dysfunction in patients with interstitial lung diseases referred for l... |
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. |
Affiliation:
|
Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil. jorgesalluh@yahoo.com.br |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adrenal Glands
/
physiopathology* Adrenal Insufficiency / epidemiology Community-Acquired Infections / blood, mortality, physiopathology Critical Illness Humans Hydrocortisone / blood* Pneumonia / blood*, mortality, physiopathology* Severity of Illness Index |
| Chemical | |
Reg. No./Substance:
|
50-23-7/Hydrocortisone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Binding to complement factors and activation of the alternative pathway by Acanthamoeba.
Next Document: Involvements of H2O2 and metallothionein in NO-mediated tomato tolerance to copper toxicity.