Serum dehydroepiandrosterone and dehydroepiandrosterone sulfate as markers of disease severity in community-acquired pneumonia
Claudine A Blum1, Philipp Schuetz1, Daiana Stolz3, Roland Bingisser4, Christian Mueller2, Michael Tamm3, Michael Trummler6, Beat Mueller5 & Mirjam Christ-Crain1
Background: Rapid and accurate risk stratification in patients with community-acquired pneumonia (CAP) is an unmet clinical need. Cortisol to DHEA ratio was put forward as a prognostic marker in sepsis. We herein validated the prognostic value of DHEA and DHEAS and of cortisol/DHEA- and cortisol-DHEAS ratios, respectively, in patients with CAP as the most common (disease resulting) sepsis-defining illness.
Methods: We assessed clinical parameters and severity of illness defined by the pneumonia severity index (PSI) and measured DHEA, DHEAS and cortisol concentrations in 181 serum samples of prospectively recruited patients with CAP. First, we calculated a linear regression model adjusted for age and gender to assess the associations of hormones and PSI. Second, we calculated a logistic regression model adjusted for age and gender to assess associations of hormones and in hospital mortality.
Results: A total of 181 patients (median age 73, 34% females) with confirmed CAP were included. Linear regression analysis showed that total cortisol (β: 0.99, P<0.001), DHEAS (β: 2.7, P<0.001) and DHEA (β: 0.9, P<0.001) were all positively associated with CAP severity as assessed with the PSI. In logistic regression analysis, cortisol (OR: 1.08, P<0.001) and DHEA (OR: 1.06, P<0.01), and to a lesser extend DHEAS (OR 1.1, P=0.07) were predictors of mortality. The ratios of cortisol/DHEA, cortisol/DHEAS and DHEA/DHEAS were not associated with the PSI and were not predictors of survival (all P=NS).
Conclusion: Cortisol, DHEA and DHEAS, but not the different ratios correlate with severity and survival in CAP. The prognostic accuracy of DHEA and DHEAS is comparable to the one of the PSI. Cortisol remains the best prognostic marker for outcome in this analysis. Thus, not only cortisol, but adrenal function in general and its possible exhaustion in severe pneumonia is an important factor for outcome and survival.