Changes in serum cortisol levels during community-acquired pneumonia: The influence of dexamethasone
Respiratory Medicine,  Clinical Article

Remmelts HHF et al. - The authors showed that an adverse outcome of community-acquired pneumonia (CAP) was associated with persisting higher total serum cortisol throughout the course of disease. Delta-cortisol could be another meaningful biomarker in CAP. Next, the data indicate that a four-day dexamethasone regimen during CAP does not lead to prolonged secondary adrenal insufficiency.

Methods
  • The authors 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, the authors analyzed serial cortisol values of 43 patients treated with a four-day regimen of dexamethasone 5 mg.

Results
  • 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.

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