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

Rondi M. Kauffmann, 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

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: We have previously demonstrated that elevated serum estradiol (E2) 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 E2 during the course of care might signal increasing patient acuity or risk of death. We hypothesized that changes from baseline serum E2 during the course of critical illness are more strongly associated with mortality than a single E2 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 E2 levels was studied. Demographics, illness severity, and E2 levels were examined, and the probability of mortality was modeled with multivariate logistic regression. Changes in E2 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 E2 levels were independently associated with mortality [admission E2 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 E2 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 E2 are associated with mortality, changes from baseline E2 in critically ill or injured adults are independently associated with mortality. Future studies of E2 dynamics may yield new indicators of patient acuity and illuminate underlying mechanisms for targeted therapy.

Original languageEnglish (US)
Pages (from-to)703-712
Number of pages10
JournalJournal of the American College of Surgeons
Volume212
Issue number4
DOIs
StatePublished - Apr 2011

Fingerprint

Critical Illness
Estradiol
Mortality
Confidence Intervals
Patient Acuity
Odds Ratio
Intensive Care Units
Logistic Models
Serum
ROC Curve
Analysis of Variance
Demography

ASJC Scopus subject areas

  • Surgery

Cite this

Kauffmann, R. M., Norris, P. R., Jenkins, J. M., Dupont, W. D., Torres, R. E., Blume, J. D., ... May, A. K. (2011). Trends in estradiol during critical illness are associated with mortality independent of admission estradiol. Journal of the American College of Surgeons, 212(4), 703-712. https://doi.org/10.1016/j.jamcollsurg.2010.12.017

Trends in estradiol during critical illness are associated with mortality independent of admission estradiol. / Kauffmann, Rondi M.; Norris, Patrick R.; Jenkins, Judith M.; Dupont, William D.; Torres, Renee E.; Blume, Jeffrey D.; Dossett, Lesly A.; Hranjec, Tjasa; Sawyer, Robert G.; May, Addison K.

In: Journal of the American College of Surgeons, Vol. 212, No. 4, 04.2011, p. 703-712.

Research output: Contribution to journalArticle

Kauffmann, RM, Norris, PR, Jenkins, JM, Dupont, WD, Torres, RE, Blume, JD, Dossett, LA, Hranjec, T, Sawyer, RG & May, AK 2011, 'Trends in estradiol during critical illness are associated with mortality independent of admission estradiol', Journal of the American College of Surgeons, vol. 212, no. 4, pp. 703-712. https://doi.org/10.1016/j.jamcollsurg.2010.12.017
Kauffmann, Rondi M. ; Norris, Patrick R. ; Jenkins, Judith M. ; Dupont, William D. ; Torres, Renee E. ; Blume, Jeffrey D. ; Dossett, Lesly A. ; Hranjec, Tjasa ; Sawyer, Robert G. ; May, Addison K. / Trends in estradiol during critical illness are associated with mortality independent of admission estradiol. In: Journal of the American College of Surgeons. 2011 ; Vol. 212, No. 4. pp. 703-712.
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abstract = "Background: We have previously demonstrated that elevated serum estradiol (E2) 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 E2 during the course of care might signal increasing patient acuity or risk of death. We hypothesized that changes from baseline serum E2 during the course of critical illness are more strongly associated with mortality than a single E2 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 E2 levels was studied. Demographics, illness severity, and E2 levels were examined, and the probability of mortality was modeled with multivariate logistic regression. Changes in E2 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 E2 levels were independently associated with mortality [admission E2 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 E2 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 E2 are associated with mortality, changes from baseline E2 in critically ill or injured adults are independently associated with mortality. Future studies of E2 dynamics may yield new indicators of patient acuity and illuminate underlying mechanisms for targeted therapy.",
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T1 - Trends in estradiol during critical illness are associated with mortality independent of admission estradiol

AU - Kauffmann, Rondi M.

AU - Norris, Patrick R.

AU - Jenkins, Judith M.

AU - Dupont, William D.

AU - Torres, Renee E.

AU - Blume, Jeffrey D.

AU - Dossett, Lesly A.

AU - Hranjec, Tjasa

AU - Sawyer, Robert G.

AU - May, Addison K.

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N2 - Background: We have previously demonstrated that elevated serum estradiol (E2) 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 E2 during the course of care might signal increasing patient acuity or risk of death. We hypothesized that changes from baseline serum E2 during the course of critical illness are more strongly associated with mortality than a single E2 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 E2 levels was studied. Demographics, illness severity, and E2 levels were examined, and the probability of mortality was modeled with multivariate logistic regression. Changes in E2 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 E2 levels were independently associated with mortality [admission E2 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 E2 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 E2 are associated with mortality, changes from baseline E2 in critically ill or injured adults are independently associated with mortality. Future studies of E2 dynamics may yield new indicators of patient acuity and illuminate underlying mechanisms for targeted therapy.

AB - Background: We have previously demonstrated that elevated serum estradiol (E2) 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 E2 during the course of care might signal increasing patient acuity or risk of death. We hypothesized that changes from baseline serum E2 during the course of critical illness are more strongly associated with mortality than a single E2 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 E2 levels was studied. Demographics, illness severity, and E2 levels were examined, and the probability of mortality was modeled with multivariate logistic regression. Changes in E2 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 E2 levels were independently associated with mortality [admission E2 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 E2 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 E2 are associated with mortality, changes from baseline E2 in critically ill or injured adults are independently associated with mortality. Future studies of E2 dynamics may yield new indicators of patient acuity and illuminate underlying mechanisms for targeted therapy.

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