The Endocrinologic Changes in Critically Ill Chronic Obstructive Pulmonary Disease Patients

ABSTRACT

Background: Alterations in the neuroendocrine system occur during critical illness. Chronic obstructive pulmonary disease (COPD) itself causes hormonal changes. The aim of this study was to determine neu roendocrine hormones of COPD patients with acute respiratory failure and to investigate the relationship between hormonal changes, mortality, and morbidity.Methods: We enrolled 21 patients (13 F/8 M) with COPD exacerbation requiring artificial airway support. Blood samples were collected on admission to the ICU, and on the day of hospital discharge. Eighteen healthy people were included as controls. Results: Female patients had lower luteinizing hormone (LH), follicle stimulating hormone (FSH), and free triiodothyronine (fT3), and higher prolactin (PRL) levels than controls on admission to the ICU (FSH: 70.3 vs. 29.3 mlU/mL; LH: 26.6 vs. 6.8 mlU/mL; fT3: 2.9 vs. 2.0 pg/mL; PRL: 12.4 vs. 21.3 ng/mL). Male patients had low testosterone and TSH and high PRL but only changes in TSH and PRL reached statistical significance (testosterone: 3.5 vs. 1.5 ng/mL, TSH: 1.1 vs. 0.5 ulU/mL, PRL: 9.7 vs. 14.2 ng/mL). Female patients had lower fT3 than males (fT3_female: 2.7 vs. fT3_male: 2.0 pg/mL). On follow-up, significantly elevated FSH and fT3 and decreased estradiol concentrations were documented among recovered women (FSH: 28.4 vs. 46.6 mlU/mL, fT3,: 2.0 vs. 2.6 pg/mL, E₂: 27.7 vs. 19.0 pg/mL). Patients had high C-reactive protein levels and acute physiologic and chronic health evaluation II scores. Mortality rate was 9.5% and a negative correlation between E₂ and duration of noninvasive mechanical ventilation and length of hospital stay was found in male patients. Conclusion: Men and women with acute respiratory failure in the presence of COPD develop significant changes in the neuroendocrine axis. Hormonal suppression vanishes with disease improvement.

Keywords: :

• Exacerbation of COPD
• Neuroendocrine changes
• Acute respiratory failure
• Artificial airway support
• APACHE II score

ACKNOWLEDGMENT

We thank Dr. Nadi Bakırcı, M.D., Associate Professor of Health Care and Statistic at Marmara University, School of Medicine, for his help with the statistics of the study.

T. Akbaş designed the study, followed the patients, gathered the raw data of the study and contributed to writing of the paper. S. Karakurt and T. Çelikel helped for the study design and contributed to writing of the paper. G. Ünlügüzel did the laboratory workup and contributed to writing of the assay part of the manuscript. S. Akalın was the chief of the study, designed and followed the study, reviewed the paper and contributed to writing of the manuscript. All authors read, edited, and ultimately approved the final manuscript.