Acute Care/Hospitalization

Increased estradiol levels during critical illness are associated with higher mortality

Studies have found that estradiol (serum E2) levels are elevated in critical illness and that higher levels are linked to death in the critically ill, regardless of sex. Now, a new study reports that serum E2 level at hospital admission and increases in serum E2 over the course of hospitalization of critically ill or injured patients are more strongly associated with the probability of death than a single admission E2 level. The study also found a positive association between levels of cytokines (hormone-like proteins involved in the body's inflammatory response) and mortality. But the researchers concluded that serum E2 was a clinically preferable indicator of mortal threat, partly because of the relatively short half-life of cytokines relative to E2.

The researchers cautioned that whether E2 is actually a mediator of the inflammatory process and contributes to outcome or is simply a marker of disease severity is not known and could not be determined from their data. Their study examined the correlation of serum E2 levels during the hospital course of surgical critical illness and changes in E2 with in-hospital 28-day all-cause mortality in a population of 1,408 critically ill and injured surgical patients who required intensive care unit care. Hormone levels were collected twice weekly until death, discharge, or day 28, whichever came first. This study was supported, in part, by the Agency for Healthcare Research and Quality (HS13833).

See "Trends in estradiol during critical illness are associated with mortality independent of admission estradiol," by Rondi M. Kauffmann, M.D., Patrick R. Norris, Ph.D., Judith M. Jenkins, M.S.N., and others in the Journal of the American College of Surgeons 212, pp. 703-713, 2011.

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