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VOLUME 22 , ISSUE 2 ( 2018 ) > List of Articles

BRIEF COMMUNICATION

Serum Estradiol Level at Intensive Care Unit Admission and Mortality in Critically Ill Patients

Luis Alejandro Sanchez-Hurtado, Rolando Lugo-Cob, Brigette C. Tejeda-Huezo, Alejandro Esquivel-Chávez, Abraham A. Cano-Oviedo, Sergio Zamora-Varela, Saira S. Gomez-Flores, Perla Arvizu-Tachiquin, José A. Baltazar-Torres

Keywords : Critical illness, estradiol, mortality, outcome

Citation Information : Sanchez-Hurtado LA, Lugo-Cob R, Tejeda-Huezo BC, Esquivel-Chávez A, Cano-Oviedo AA, Zamora-Varela S, Gomez-Flores SS, Arvizu-Tachiquin P, Baltazar-Torres JA. Serum Estradiol Level at Intensive Care Unit Admission and Mortality in Critically Ill Patients. Indian J Crit Care Med 2018; 22 (2):96-99.

DOI: 10.4103/ijccm.IJCCM_395_16

License: CC BY-ND 3.0

Published Online: 00-02-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Context: It has been observed that sex hormones may play a role in inflammatory processes and mortality of critically ill patients. Aims: The aim was evaluated the relationship between serum estradiol level at Intensive Care Unit (ICU) admission and mortality of critically ill patients. Settings and Design: This study was a prospective cohort conducted in one mixed ICU. Subjects and Methods: In heterogeneous group of critically ill patients admitted to the ICU, we measured serum estradiol at admission time. Statistical Analysis Used: The discrimination to predict mortality of serum estradiol level was assessed by the receiver-operating curve (ROC) curve and its association with mortality by logistic regression analysis. Results: We included 131 patients, 57.3% of which were male. The serum estradiol level measured at ICU admission was significantly higher in nonsurvivors than in survivors: 116 versus 67.2 pg/mL, respectively (P < 0.0001). The area under the ROC of serum estradiol level to predict mortality was 0.74 (P < 0.0001). Serum estradiol level ≥97.9 pg/mL had sensitivity of 60%, specificity of 90%, positive predictive value of 64%, negative predictive value of 88%, positive likelihood ratio of 6, and negative likelihood ratio of 0.44, for predicting mortality. In multivariate analysis, it had relative risk of 6.47 (P = 0.002) for ICU mortality. Conclusions: The serum estradiol level is elevated in critically ill patients, regardless of gender, especially in those who die. It has good discriminative capacity to predict mortality, and it is an independent risk factor for death in this group of patients.


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  1. Dossett LA, Swenson BR, Evans HL, Bonatti H, Sawyer RG, May AK, et al. Serum estradiol concentration as a predictor of death in critically ill and injured adults. Surg Infect (Larchmt) 2008;9:41-8.
  2. Sakr Y, Elia C, Mascia L, Barberis B, Cardellino S, Livigni S, et al. The influence of gender on the epidemiology of and outcome from severe sepsis. Crit Care 2013;17:R50.
  3. Kauffmann RM, Norris PR, Jenkins JM, Dupont WD, Torres RE, Blume JD, et al. Trends in estradiol during critical illness are associated with mortality independent of admission estradiol. J Am Coll Surg 2011;212:703-12.
  4. Romo H, Amaral AC, Vincent JL. Effect of patient sex on Intensive Care Unit survival. Arch Intern Med 2004;164:61-5.
  5. Lu CW, Liu LC, Hsieh YC, Yang LH, Chen RJ, Hsieh CH, et al. Increased admission serum estradiol level is correlated with high mortality in patients with severe acute pancreatitis. J Gastroenterol 2013;48:374-81.
  6. Feng JY, Liu KT, Abraham E, Chen CY, Tsai PY, Chen YC, et al. Serum estradiol levels predict survival and acute kidney injury in patients with septic shock – A prospective study. PLoS One 2014;9:e97967.
  7. Bengtsson AK, Ryan EJ, Giordano D, Magaletti DM, Clark EA.17beta-estradiol (E2) modulates cytokine and chemokine expressionin human monocyte-derived dendritic cells. Blood 2004;104:1404-10.
  8. Dossett LA, Swenson BR, Heffernan D, Bonatti H, Metzger R, Sawyer RG, et al. High levels of endogenous estrogens are associated with death in the critically injured adult. J Trauma 2008;64:580-5.
  9. May AK, Dossett LA, Norris PR, Hansen EN, Dorsett RC, Popovsky KA, et al. Estradiol is associated with mortality in critically ill trauma and surgical patients. Crit Care Med 2008;36:62-8.
  10. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-29.
  11. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707-10.
  12. Combes A, Luyt CE, Trouillet JL, Nieszkowska A, Chastre J. Gender impact on the outcomes of critically ill patients with nosocomial infections. Crit Care Med 2009;37:2506-11.
  13. Heffernan DS, Dossett LA, Lightfoot MA, Fremont RD, Ware LB, Sawyer RG, et al. Gender and acute respiratory distress syndrome in critically injured adults: A prospective study. J Trauma 2011;71:878-83.
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