Serum Cortisol Level as a Predictor of Severity and Outcome in Community Acquired Pneumonia

Abstract

Community Acquired Pneumonia imposes a considerable burden on health care facilities in developing countries like ours where resources are already scarce, therefore the need for simple and easy methods of stratification of the cases with regard to severity is undeniable. Recent studies have shown that cortisol level is a reliable predictor of outcome and risk stratification in patients with Community Acquired Pneumonia, therefore cortisol level estimation is advisable which will help guide the management, and reduce the burden on the individual and health care facilities. The most established scoring systems are the PSI-score and the CURB or CRB-65 scores, which perform comparably for mortality prediction and identification of low risk patients suitable for an outpatient management strategy. 1 additionally, biomarkers have been found to improve risk stratification and management decisions in CAP. 2 The aim of our study is to determine the serum cortisol level as a predictor of severity and outcome in Community Acquired Pneumonia. MATERIAL AND METHODS:The study was conducted in the Department of Medicine, Pt. Jawaharlal Nehru Memorial Medical College and Dr. B.R.A.M. Hospital, Raipur (C. G.) among 50 patients admitted in medicine ward who were diagnosed as a case of pneumonia on admission. The study was conducted between April 2013-September 2014. RESULTS: Out of the 17 patients with a CURB-65 score of 0-1, the mortality is 0, 2 out of the 17 patients with CURB-65 score of 2 died within 30 days of admission and 6 out of the 16 patients with a CURB-65 score of 3-5 died within 30 days of admission which was statistically significant (p<0.01, OR= 9.75). Out of the 37 patients with a Cortisol level <27.23, there was negative outcome on 5.4% of the patients. Out of the 13 patients with Cortisol level >27.23, 46.15% had a negative outcome and this findings was statistically significant with p value of <0.01 and OR=8.53. CONCLUSION: The findings in our study indicates that severity of pneumonia is related to serum cortisol level which has a strong prediction as to the course of the disease and outcome of the patients. Strong association between elevated cortisol levels and severity of illness and the risk of death have been demonstrated. There is a positive correlation between CURB-65 score and serum cortisol level.