PURPOSE: Cortisol levels correlate with mortality in patients with sepsis. Patients with sepsis evolve into septic shock before developing organ failure, the leading cause of death. The aim of our study was to determine the association between the cortisol level at the time of admission to the ICU and the need for vasopressor (developing shock) and endotracheal intubation in hemodynamically stable patients with pneumonia.
METHODS: Cortisol level was measured in patients admitted to the ICU with the clinical diagnosis of pneumonia. Patients were excluded if they required vasopressors or mechanical ventilation at the time of admission. Patients were prospectively followed for 72 hours to document instances of vasopressor use and intubation.
RESULTS: 44 patients met the inclusion criteria. The patients had the following baseline characteristics: white blood count of 11±8 k/microliter, respiratory rate of 25±7 bpm, heart rate of 108±22 bpm, mean arterial pressure of 94±23 mmHg, temperature of 99±2 degree Fahrenheit, Glasgow Coma Scale of 14±1 and oxygen saturation of 92±7 percent. The patients that required vasopressors (n=11) had higher cortisol levels than patients that did not require vasopressors (35±16 vs. 21±13, p= 0.007). The APACHE III scores were similar between the two groups. The cortisol level remained a powerful predictor of vasopressor use after adjustment for disease severity using the APACHE III score. The cortisol tended to be higher in patients that required mechanical ventilation (n=19) than in patients that did not (28±15 vs. 22 ±15, p=0.2). The APACHE III score was similar between the two groups (47±46 vs. 45±10, p=0.7).
CONCLUSION: In patients admitted to the ICU with the clinical diagnosis of pneumonia, cortisol level is a predictor for vasopressor use.
CLINICAL IMPLICATIONS: Hemodynamically stable patients admitted to the ICU with the clinical diagnosis of pneumonia that have an elevated cortisol level should be aggressively resuscitated with fluid because they are at risk of developing shock that could lead to organ failure.
DISCLOSURE: Renaud Gueret, No Financial Disclosure Information; No Product/Research Disclosure Information