Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Apr;212(4):703-12; discussion 712-3.
doi: 10.1016/j.jamcollsurg.2010.12.017.

Trends in estradiol during critical illness are associated with mortality independent of admission estradiol

Rondi M Kauffmann  1 , Patrick R Norris, Judith M Jenkins, William D Dupont, Renee E Torres, Jeffrey D Blume, Lesly A Dossett, Tjasa Hranjec, Robert G Sawyer, Addison K May
Affiliations

Trends in estradiol during critical illness are associated with mortality independent of admission estradiol

Rondi M Kauffmann et al. J Am Coll Surg. 2011 Apr.

Abstract

Background: We have previously demonstrated that elevated serum estradiol (E(2)) at intensive care unit (ICU) admission is associated with death in the critically ill, regardless of sex. However, little is known about how changes in initial E(2) during the course of care might signal increasing patient acuity or risk of death. We hypothesized that changes from baseline serum E(2) during the course of critical illness are more strongly associated with mortality than a single E(2) level at admission.

Study design: A prospective cohort of 1,408 critically ill or injured nonpregnant adult patients requiring ICU care for ≥48 hours with admission and subsequent E(2) levels was studied. Demographics, illness severity, and E(2) levels were examined, and the probability of mortality was modeled with multivariate logistic regression. Changes in E(2) were examined by both analysis of variance and logistic regression.

Results: Overall mortality was 14.1% [95% confidence interval (CI) 12.3% to 16%]. Both admission and subsequent E(2) levels were independently associated with mortality [admission E(2) odds ratio 1.1 (CI 1.0 to 1.2); repeat estradiol odds ratio 1.3 (CI 1.2 to1.4)], with subsequent values being stronger. Changes in E(2) were independently associated with mortality [odds ratio 1.1 (CI 1.0 to 1.16)] and improved regression model performance. The regression model produced an area under the receiver operating characteristic curve of 0.80 (CI 0.77 to 0.83).

Conclusions: Although high admission levels of E(2) are associated with mortality, changes from baseline E(2) in critically ill or injured adults are independently associated with mortality. Future studies of E(2) dynamics may yield new indicators of patient acuity and illuminate underlying mechanisms for targeted therapy.

Trial registration: ClinicalTrials.gov NCT00170560.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram of method for cohort selection with mortality rates and corresponding 95% confidence intervals (CI) for entire population, included cohort, and excluded cohort.
Figure 2
Figure 2
Risk of death by Admission Estradiol Quartile
Figure 3
Figure 3
Risk of death by trend in estradiol quartile
Figure 4
Figure 4
Probability of Death by Unadjusted Difference in Estradiol
Figure 5
Figure 5
Probability of Death by Unadjusted Admission and Repeat Estradiol
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Gannon CJ, PM, Tracy JK, McCarter RJ, Napolitano LM. Male gender is associated with increased risk for postinjury pneumonia. Shock. 2004;21(5):410–414. - PubMed
    1. Berry C, LE, Tillou A, Cryer G, Margulies DR, Salim A. The effect of gender on patients with moderate to severe head injury. Journal of Trauma, Injury, Infection and Critical Care. 2009;67(5):950–953. - PubMed
    1. Zellweger R, WM, Ayala A, Stein S, DeMaso CM, Chaudry IH. Females in proestrus state maiontain splenic immune functions and tolerate sepsis better than males. Crit Care Med. 1997;25(1):106–110. - PubMed
    1. Croce MA, FT, Malhotra AK, Bee TK, Miller PR. Does gender difference influence outcome? Journal of Trauma, Injury, Infection and Critical Care. 2002;53(5):889–894. - PubMed
    1. Morris JA, Jr, ME, Damiano AM, et al. Mortality in trauma patients: the interaction between host factors and severity. Journal of Trauma, Injury, Infection and Critical Care. 1990;30:1476–1482. - PubMed

Publication types

Associated data