The association of serum total cortisol and pneumonia severity index

OBJECTIVE: To study the relation between severity of pneumonia and serum cortisol level in a cohort of Egyptian patients.

METHODS: All consecutive adult patients with community acquired pneumonia (CAP) admitted to Mansoura University Hospital, Mansoura, Egypt between March 2008 and December 2008 were considered for study inclusion. Exclusion criteria were patients with HIV infection, impaired immune systems, collagen vascular disease, interstitial pneumonia, chronic obstructive pulmonary disease (COPD), asthma requiring 10 mg of prednisolone at least daily, active malignant neoplasm, congestive heart failure (CHF), liver cirrhosis, or other causes of hypoproteinemia and septic shock. Pneumonia severity was scored at hospital admission according to pneumonia severity index (PSI) using the PORT criteria. The serum total cortisol was measured at hospital admission using ELISA.

RESULTS: The present study comprised 23 adult patients with CAP: 14 male and 9 females with a mean age of 47 ± 16.7 years. Total serum cortisol (mean 483.11 ± 387.91 nmol/L) was positively correlated (p=0.012, R=0.576) with pneumonia severity as assessed by the PSI. Moreover, the total serum cortisol levels showed significantly negative correlation with arterial oxygen tension (R=-0.500, p=0.035), oxygen saturation % (R=0.450, p=0.029), and bicarbonate level (R=0.266, p=0.03), as well as a significant positive correlation with the extent of lung involvement (p=0.041).

CONCLUSION: Total serum cortisol showed a significantly positive correlation with the severity of CAP assessed by the PORT index (PSI) in our study population. A single measurement of total serum cortisol may provide helpful information as the complex 20-variables, which are used in pneumonia severity index.