Serum Cortisol as a Predictor of Major Adverse Pulmonary Event in Emergency Department Acutely Dyspneic Patients

Abstract

Cortisol is a steroid hormone released from the adrenal glands in response to stressful conditions. Elevated cortisol levels have been described in stress, but it is unclear whether these are associated with adverse outcomes. In this study, we assess whether cortisol levels drawn in patients presenting with dyspnea to the ED were a predictor of major adverse pulmonary event (MAPE). In 87 patients presenting with dyspnea to the ED, cortisol levels were determined. Patients were then assessed to determine the following MAPE: endotracheal intubation (ETI) in the ED, admission to the intensive care unit (ICU), and in-hospital all-cause mortality. Forty-four patients (50.6%) were female and 33 (37.9%) were diagnosed with heart failure. Cortisol levels in patients with and without MAPE were 34.3μg/dL and 23.8μg/dL, respectively (p<0.001). Also, cortisol levels were found higher in patients intubated in the ED than nonintubated patients (54.2μg/dL vs 25.7μg/dL, p<0.001), higher in patients admitted to the ICU (38.7μg/dL vs 24 μg/dL, p<0.001), and higher in patients who died in hospital (50μg/dL vs 24.3μg/dL, p<0.001). The area under the ROC curve using cortisol to detect any component of MAPE—ETI or ICU admission or in-hospital all-cause mortality—was 0.76 (95% CI, 0.65-0.84). A cortisol value of 31.4μg/dL had sensitivity of 70.8% and specificity of 79.4% for predicting MAPE. Patients in the MAPE group had higher serum cortisol levels than those without any MAPE. Cortisol may be used as a marker to predict MAPE in nontraumatic acutely dyspneic adult patients on ED admission.

Serum cortisol level as a useful predictor of surgical disease in patients with acute abdominal pain

“…The studies showed that high serum cortisol levels can predict adverse outcome in patients with severe community acquired pneumonia, cardiac event risk in chronic heart failure, survival state in resuscitated cardiopulmonary arrest, mortality risk in chronic haemodialysis, and development of postoperative cognitive dysfunction following cardiac surgery. (9)(10)(11)(12)(13)(14)(15) To our knowledge, this is the first study to investigate the association between cortisol levels and surgical abdominal pain. It's an important problem to estimate surgical disease in patients with abdominal pain, especially at the early stage of 21) NLR is a predictor of acute inflammation and was recently studied in many clinical conditions for the diagnosis or prognosis.…”

ACE2 overexpression in corticotropin-releasing-hormone cells offers protection against pulmonary hypertension

“…Corticotropin-releasing hormone (CRH) neurons, well-known mediators of the HPA axis, are key in the autonomic response to stress ( Wang et al, 2018 ), receive dense input from the nucleus of the solitary tract (NTS) and are the most highly activated neurons in the PVN following acute hypoxia exposure ( Ruyle et al, 2018 ). Additionally, Dikme (2018) proposed serum cortisol as a putative marker to predict major adverse pulmonary events in adults with acute nontraumatic dyspnea. Furthermore, there is a robust association of variations in the CRH receptor 1 (CRHR1) and CRH-binding protein (CRHBP) in neonates with hypoxemic respiratory failure and clinical diagnosis of persistent PH of the newborn (PPHN).…”