Evaluation of the cortisol/DHEAS ratio in patients admitted to an internal medicine ward

Background: Scientific literature has shown a growing interest in the relationship between the cortisol/DHEAS (dehydroepiandrosterone sulfate) ratio and aging process, morbidity and mortality. Interestingly a reduced ratio seems to be associated to a favorable prognostic significance for healthy aging, while an elevated ratio may suggest a negative prognostic significance. Objectives: To evaluate the correlations between cortisol values, DHEAS levels and their ratio, with age, mortality and several parameters which are considered expression of patient frailty and morbidity. Methods: Morning serum cortisol and DHEAS were measured in 81 patients admitted to the Internal Medicine Division of the San Luigi Gonzaga University Hospital in Orbassano, from July to September 2019. The correlations between the aforementioned hormonal values and the following parameters were investigated: age, BRASS Scale (Discharge Planning Risk Assessment; higher the score, higher the risk of institutionalization), Braden Scale (Pressure Ulcer Risk Assessment; higher the score, lower the risk of developing pressure ulcers), Conley Scale (Fall Risk Assessment; higher the score, higher the risk of falls), ECOG Performance Status group (higher the grade, worse the performance status), the number of falls per year and mortality over a period of 30 days after discharge. Results: Our cohort consisted of 81 adult patients (43 females, 38 males), with a median age of 78 years (interquartile range 72-85). The main reasons for hospitalization included infectious diseases, exacerbation of chronic conditions (heart failure, chronic obstructive pulmonary disease, renal insufficiency) and challenges in managing elderly patients with cognitive decline at home. Cortisol levels and the cortisol/DHEAS ratio were positively correlated with age, ECOG performance status and BRASS scale scores, while they were negatively Braden Scale scores. DHEAS values were negatively correlated with age and ECOG performance status, while they were positively correlated with BRADEN scale scores. The Conley scale scores and the number of falls per year did not show any statistically significant correlation with cortisol or DHEAS. Death occurred in 18.7% of cases and the group of dead patients showed at baseline higher cortisol levels and cortisol/DHEAS ratio than alive patients, without statistically significant difference in DHEAS levels. Conclusions: This study represents a pilot experience of investigation of the role of cortisol, DHEAS and their ratio as indicators of increased fragility, morbidity and mortality. In our cohort, higher the cortisol levels and the cortisol/DHEAS ratio, higher the risk of institutionalization and developing pressure ulcers, and worse the performance status. The correlation between DHEAS values and these parameters was in the opposite direction, with the exception of DHEAS’ correlation with the risk of institutionalization, which was not significant. Moreover, higher cortisol levels could be associated with higher risk of mortality. It is still to determine whether the elevated Cortisol/DHEAS ratio represents a simple expression of acute stress, with physiological significance, or a pathogenic event that, if corrected, could improve health outcomes and reduce patient frailty. Given the small sample size, the results of the study must be considered of exploratory nature. Nevertheless, they provide useful insights into the role of the adrenal hormones in frailty, morbidity and mortality