Cortisol levels and mortality in severe sepsis

Sam, Susan; Corbridge, Thomas C.; Mokhlesi, Babak; Comellas, Alejandro P.; Molitch, Mark E.

doi:10.1111/j.1365-2265.2004.01923.x

Cited by 140 publications

(90 citation statements)

References 39 publications

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“…Of the few studies examining the cortisol:DHEAS ratio and total mortality, our findings confirm previous links (4). The failure of cortisol alone to predict mortality contrasts with some previous findings (12)(13)(14), but is in agreement with others (9, 15). As we stated above, DHEAS decreases with age (32), thus increasing the relative levels of cortisol, so it is possible that cortisol influences mortality in older populations as opposed to middleaged populations.…”

Section: Discussioncontrasting

confidence: 55%

“…For example, higher cortisol was associated with increased mortality in patients with heart failure (12), sepsis (13) and stroke (14), although this is not a universal finding (15). DHEAS has been shown to be negatively associated with total and cardiovascular disease mortality in selected studies, with ischaemic heart disease (16) in women, with all-cause mortality in men only (17,18), and with both all-cause and cardiovascular disease mortality in older people (19) of both sexes (20).…”

Section: Introductionmentioning

confidence: 99%

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Cortisol, DHEA sulphate, their ratio, and all-cause and cause-specific mortality in the Vietnam Experience Study

Phillips

Carroll²,

Gale

et al. 2010

European Journal of Endocrinology

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Objectives: The aim of the present analyses was to examine the association between cortisol, DHEA sulphate (DHEAS) and the cortisol:DHEAS ratio and mortality. Design: This was a prospective cohort analysis. Methods: Participants were 4255 Vietnam-era US army veterans. From military service files, telephone interviews and a medical examination, occupational, socio-demographic and health data were collected. Contemporary morning fasted cortisol and DHEAS concentrations were determined. Mortality was tracked over the subsequent 15 years. The outcomes were all-cause, cardiovascular disease, cancer, other medical mortality and external causes of death. Cox proportional hazard models were tested, initially with adjustment for age, and then with adjustment for a range of candidate confounders. Results: In general, cortisol concentrations did not show an association with all-cause or cause-specific mortality. However, in age-adjusted and fully adjusted analyses, DHEAS was negatively related to all-cause, all cancers and other medical mortality; high DHEAS concentrations were protective. The cortisol:DHEAS ratio was also associated with these outcomes in both age-adjusted and fully adjusted models; the higher the ratio, the greater the risk of death. Conclusions: DHEAS was negatively associated, and the ratio of cortisol to DHEAS was positively associated with all-cause, cancer and other medical cause mortality. Further experimental study is needed to elucidate the mechanisms involved in these relationships.

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Section: Discussioncontrasting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Cortisol, DHEA sulphate, their ratio, and all-cause and cause-specific mortality in the Vietnam Experience Study

Phillips

Carroll²,

Gale

et al. 2010

European Journal of Endocrinology

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“…to characterise patients as 'responders' (those who had an increment of O250 nmol/l in serum cortisol) and 'non-responders' (those who had an increment of !250 nmol/l in their serum cortisol levels), regardless of their baseline values (19,20). Other studies evaluated the prognostic value of measuring baseline and cosyntropin-stimulated serum cortisol (20,26,27). Proposed lower thresholds for stress-elevated basal cortisol concentrations vary widely in the literature and it has been proposed that cortisol levels !414 nmol/l are in keeping with adrenal insufficiency, while stimulated or non-stimulated levels O827-940 nmol/l are unlikely to indicate any deficiency (9,12).…”

Section: Discussionmentioning

confidence: 99%

Assessing adrenal status in patients before and immediately after coronary artery bypass graft surgery

Debono¹,

Sheppard²,

Irving³

et al. 2011

European Journal of Endocrinology

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Objective: Patients with cortisol deficiency poorly tolerate any systemic inflammatory response syndrome (SIRS), and may die if not treated with sufficient exogenous glucocorticoids. Controversy surrounds what constitutes a 'normal' adrenal response in critical illness. This study uses conventional tests for adrenal insufficiency to investigate cortisol status in patients undergoing elective coronary artery bypass surgery, a condition frequently associated with SIRS. Design: A prospective, observational study. Methods: Thirty patients with impaired left ventricular function (ejection fraction O23% !50%) underwent basal ACTH measurement, and a short cosyntropin test (250 mg, i.v.) 1 week preoperatively, and at C4 h following induction of general anaesthesia. Preoperatively, a 30 min cortisol level post cosyntropin O550 nmol/l was taken as a normal response. Results: Prior to surgery, all patients had a normal response to cosyntropin. Postoperatively, eight patients (26.7%) did not achieve stimulated cortisol levels O550 nmol/l and the mean peak cortisol postoperatively was lower (1048 vs 730 nmol/l; P!0.001). There was a significant rise in ACTH after surgery (21 vs 184 ng/l; PZ0.007) and reduction in D-cortisol post cosyntropin (579 vs 229 nmol/l; P!0.001). There was no change in basal cortisol pre-and post-operatively (447 vs 501; PZ0.4). All patients underwent routine, uneventful postoperative recovery. Conclusion: Up to one quarter of patients with a normal cortisol status preoperatively demonstrated a raised ACTH and deficient cortisol response postoperatively. Despite these responses, all patients had uneventful outcomes. These data reinforce the need for caution when interpreting results of endocrine testing following major surgery or in the intensive care environment, and that prognostic value of these results may be of limited use.

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“…A stress condition due to disease activity of SLE might also contribute to increased cortisol levels. 18,19 We also detected that not only mothers but also neonates born from mice with SLE suffered from serious complications. Survival rate of neonates born from mothers with SLE was significantly lower compared to healthy ones.…”

mentioning

confidence: 88%

Low Birth Weight and Maternal and Neonatal Deaths are Complications of Systemic Lupus Erythematosus in Pregnant Pristane Induced Lupus Mice

et al. 2015

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Objectives: This study aims to investigate the relationship between systemic lupus erythematosus and pregnancy in pristane induced lupus mice model, including the pregnancy outcome for mothers and neonates. Materials and methods: Sixteen female Balb/c mice 6-8 week-old were separated into two groups: pristane induced lupus (PIL) mice group that received a single intraperitoneal injection of 0.5 ml of pristane and healthy control (HC) group that received phosphate-buffered saline injection. At one month after injection, all mice were mated with 8-10 week-old male Balb/c mice. All mice from both groups were observed for body weight and survival. On the day of births; number of neonates born, birth weight, and length of neonates were calculated. Neonates were also monitored for survival rate and their ages along the study. Results: There was no statistically significant difference in body weight before and after delivery, survival rate during pregnancy, number of neonates born, and gestational ages of mothers from both groups. Mothers began to die in the postpartum period. On third day after delivery, 0% of mothers from PIL group survived whereas 100% mothers from HC group survived (p=0.000). Of neonates born from PIL group, 15% survived at the end of fifth day after birth whereas 100% of neonates from HC group still survived (p=0.000). Neonates from PIL group also had significantly lower body weight and body length at birth compared to HC group (p=0.000 and p=0.000, respectively). Conclusion: Maternal and neonatal death, low birth weight, and low birth length are complications of systemic lupus erythematosus at pregnancy in pristane induced lupus mice model.

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Cortisol levels and mortality in severe sepsis

Cited by 140 publications

References 39 publications

Cortisol, DHEA sulphate, their ratio, and all-cause and cause-specific mortality in the Vietnam Experience Study

Cortisol, DHEA sulphate, their ratio, and all-cause and cause-specific mortality in the Vietnam Experience Study

Assessing adrenal status in patients before and immediately after coronary artery bypass graft surgery

Low Birth Weight and Maternal and Neonatal Deaths are Complications of Systemic Lupus Erythematosus in Pregnant Pristane Induced Lupus Mice

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