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Clin Chem Lab Med. 2018 Mar 28;56(4):669-680. doi: 10.1515/cclm-2017-0873.

Association of adrenal hormone metabolites and mortality over a 6-year follow-up in COPD patients with acute exacerbation.

Author information

1
Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland.
2
Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland.
3
Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
4
Basel University Medical Clinic Liestal, Liestal, Switzerland.
5
Department of Internal Medicine, Bürgerspital Solothurn, Solothurn, Switzerland.
6
Department of Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland.
7
Department of Internal Medicine, Kantonsspital Lucerne, Lucerne, Switzerland.

Abstract

BACKGROUND:

The release of hormones from the adrenal gland is vital in acute and chronic illnesses such as chronic obstructive pulmonary disease (COPD) involving recurrent exacerbations. Using a metabolomic approach, we aim to investigate associations of different adrenal hormone metabolites with short- and long-term mortality in COPD patients.

METHODS:

We prospectively followed 172 COPD patients (median age 75 years, 62% male) from a previous Swiss multicenter trial. At baseline, we measured levels of a comprehensive spectrum of adrenal hormone metabolites, including glucocorticoid, mineralocorticoid and androgen hormones by liquid chromatography coupled with tandem mass spectrometry (MS). We calculated Cox regression models adjusted for gender, age, comorbidities and previous corticosteroid therapy.

RESULTS:

Mortality was 6.4% after 30 days and increased to 61.6% after 6 years. Higher initial androgen hormones predicted lower long-term mortality with significant results for dehydroepiandrosterone (DHEA) [adjusted hazard ratio (HR), 0.82; 95% confidence interval (CI), 0.70-0.98; p=0.026] and dehydroepiandrosterone sulfate (DHEA-S) (adjusted HR, 0.68; 95% CI, 0.50-0.91; p=0.009). An activation of stress hormones (particularly cortisol and cortisone) showed a time-dependent effect with higher levels pointing towards higher mortality at short term, but lower mortality at long term. Activation of the mineralocorticoid axis tended to be associated with increased short-term mortality (adjusted HR of aldosterone, 2.76; 95% CI, 0.79-9.65; p=0.111).

CONCLUSIONS:

Independent of age, gender, corticosteroid exposure and exacerbation type, adrenal hormones are associated with mortality at short and long term in patients with COPD exacerbation with different time-dependent effects of glucocorticoids, androgens and mineralocorticoids. A better physiopathological understanding of the causality of these effects may have therapeutic implications.

KEYWORDS:

adrenal hormones; chronic obstructive pulmonary disease; dehydroepiandrosterone; dehydroepiandrosterone sulfate; mortality prediction

PMID:
29220883
DOI:
10.1515/cclm-2017-0873
[Indexed for MEDLINE]

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