Chronic critical illness: high levels of estrogens and mortality

Introduction

Chronic critical illness is characterized by a severe metabolic disorder, caused by the loss of the physiologic hypothalamic and pituitary functions and the onset of the so-called wasting syndrome, as many studies have just confirmed [1]. In this study we assessed the correlation between the neuroendocrine pattern in chronic ICU patients and mortality.

Methods

The patients enrolled were 25 (18 male and five female) with a mean age of 67 years and APACHE II score of 12 ± 5. We excluded females in a premenopausal state, patients with previous endocrine problems or in therapy with dopamine, high dose of cortisone or amiodarone. In these patients, we evaluate, on the seventh day of stay in the ICU (considered the chronic phase of critical illness), the mean value of four nocturnal hormonal measurements (LH, FSH, estrogen, testosterone, DHEAS, androstenedione, androstenediol, progesterone, TSH, FT3, FT4, RT3, GH, IGF1, prolactin, cortisol). Furthermore, we observed hormonal patterns in people who died in the ICU.

Results

We found statistical evidence in the correlation of high levels of estrogens, related to aromatase increased function [2], and the percentage of death. In the group of patients with estrogens more than 50 pg/ml, six of them died, while if estrogens were normal or low, none died (Figure 1). Survivors and nonsurvivors did not differ by mechanism of injury or APACHE score (11.6 vs 11.8). Medium serum estradiol levels were 44.96 pg/ml in survivors and 115.08 pg/ml in nonsurvivors.

Figure 1

Conclusions

To date, the role of these hormones in critical illness pathophysiology and the increase of estrogen levels are still uncertain. Further studies are required.