Cortisol and dehydroepiandrosterone sulphate levels in ICU patients upon admission correlate with severity of disease

To date, the relationship between cortisol and dehydroepiandro-sterone sulphate (DHEAs) levels upon admission and the severity of disease in ICU patients remains controversial.

To further clarify this, 150 consecutive mechanically ventilated, critically ill patients (120 men), with diverse underlying diagnoses, having a median age of 50 years (range: 17–84 years) were investigated. Severity of illness was assessed by the APACHE II scoring system. Hypocortisolism was defined as cortisol below 15 mcg/dl. Upon admission to the ICU, blood was drawn to measure cortisol and DHEAs. Median APACHE II score was 11 (range: 1–35). Hormonal measurements were as follows: median cortisol and DHEAs levels were 16 μg/dl (range: 0–63 μg/dl) and 1335 ng/ml (range: 50–7238 ng/ml), respectively. Overall, 60 patients (40%) had hypocortisolism and 46 patients (31%) had DHEAs levels below the local reference ranges (normal values: 800–5600 ng/ml). For the entire patient population, there was a significant positive correlation between APACHE II scores and cortisol concentrations (r = 0.33, P < 0.05). Furthermore, APACHE II correlated negatively with DHEAs levels (r = -0.30, P < 0.05).

In conclusion, these data show a positive correlation between APACHE II scores and cortisol concentrations. Also evident is the negative correlation between severity of acute illness and DHEAs levels.