Evaluation of adrenal function in critically ill children

Balbão, Viviane M. P.; Costa, Marcela M. A.; Castro, Margaret de; Carlotti, Ana P. C. P.

doi:10.1111/cen.12444

Cited by 15 publications

(20 citation statements)

References 38 publications

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“…In our study, the prevalence of CIRCI was 18.5% in comparison to 25.0% in another study on PICU patients with pediatric acute lung injury/acute respiratory distress syndrome 25 and 39.6% and 44.4% in patients with severe sepsis and septic shock respectively 26 . In addition, our study found no association between CIRCI and the reported mortality rate in accordance with a previous study 27 .…”

Section: Discussionsupporting

confidence: 92%

Relation between Baseline Total Serum Cortisol Level and Outcome in Pediatric Intensive Care Unit

Bekhit

Mohamed

Yousef

et al. 2019

Sci Rep

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Elevated cortisol level is an component of the stress response. However, some patients have low cortisol levels; a condition termed: critical illness-related corticosteroid insufficiency (CIRCI). Basal cortisol levels during PICU admission may be related to outcome. This prospective cohort study aimed to assess basal total serum cortisol levels and their relation to outcome in PICU. The study included 81 children over 6 months. Total serum cortisol was assessed using an early morning sample. The severity of illness was assessed using the PRISM-III score. Outcome measures included mechanical ventilation duration, use of inotropic support, length of stay, mortality. Comparison between patients’ subgroups according to total serum cortisol levels revealed significantly higher PRISM-III score in patients with total serum cortisol levels. In addition, those patients had a significantly higher mortality rate when compared with patients with low and normal total serum cortisol levels. Multivariate logistic regression analysis recognized high total serum cortisol level and PRISM-III score as significant predictors of mortality. We concluded that PRISM-III score and elevated total serum cortisol levels are significant predictors of mortality in the PICU. Although CIRCI is prevalent in this population, it wasn’t associated with an increased mortality rate.

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Section: Discussionsupporting

confidence: 92%

Relation between Baseline Total Serum Cortisol Level and Outcome in Pediatric Intensive Care Unit

Bekhit

Mohamed

Yousef

et al. 2019

Sci Rep

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“…Our results are in accordance with previous data indicating that critically ill children have higher salivary cortisol concentrations. 23 In addition, in this cohort, extremely high concentrations of sAA were observed, although considerable variation in levels was noted ( Table 3 ). Indeed, in our cohort, although levels of SIgA were significantly higher when compared to those reported in healthy children 25 , 26 ( Table 1 ), a significant variation was observed ( Table 3 ).…”

Section: Discussionmentioning

confidence: 67%

“…Most recently, Starzak et al 25 reported a median level of 2.439 ± 1.192 mg/dL. Regarding critically ill children, Balbao et al 23 reported values ranging between 7.7 and 448.3 nmol/L for salivary cortisol in children aged 0.5–8.3 years. Our results are in accordance with previous data indicating that critically ill children have higher salivary cortisol concentrations.…”

Section: Discussionmentioning

confidence: 99%

Salivary biomarkers may measure stress responses in critically ill children

et al. 2018

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Objective:Measurement of salivary biomarkers can provide important information regarding hypothalamic–pituitary–adrenal axis activity both under normal conditions as well as in response to psychological or physical stress. Our aim was to correlate salivary stress markers, such as cortisol, α-amylase and immunoglobulin A, with the Pediatric Risk Index Score of Mortality, underlying disease (pathologic, trauma and postoperative), need for mechanical ventilation/sedation and time lag between onset of illness and admission in children admitted in the pediatric intensive care unit.Methods:We enrolled 79 pediatric intensive care unit patients (2–14 years) over a 2-year period, which satisfy the including criteria, but finally salivary biomarkers were evaluated in 65 patients. Saliva samples were collected within 24 h of admission at 8 a.m., 2 p.m. and 8 p.m. to examine potential disruption of circadian rhythm.Results:Overall, the salivary biomarkers were increased; specifically, median values were (a) cortisol at 8 a.m.: 50.04 nmol/L, 2 p.m.: 30.69 nmol/L and 8 p.m.: 247.12 nmol/L; (b) α-amylase: at 8 a.m.: 22.567 U/L; 2 p.m.: 22.702 U/L and 8 p.m.: 21.484 U/L and (c) IgA at 8 a.m.: 95.10 mg/dL, 2 p.m.: 88.55 mg/dL and 8 p.m.: 80.80 mg/dL. Significantly higher levels were demonstrated in children younger than 6 years and those with Pediatric Risk Index Score of Mortality ⩾8 upon admission. Disturbances in circadian rhythm were observed. Cortisol circadian rhythm disturbance was observed only in children with Pediatric Risk Index Score of Mortality score ⩾8 upon admission while maintaining normal α-amylase circadian rhythm, which was associated with less than 3 days hospitalization in pediatric intensive care unit. No daily variance in IgA was observed.Conclusion:Salivary biomarkers may serve, in critically ill children, as a sensitive, non-invasive method, important for the early recognition of those at high risk and guiding intervention, before clinical deterioration, promoting the quality of health care in pediatric population.

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“…Because diagnostic criteria of relative adrenal insufficiency (RAI) vary, it is difficult to accurately determine the incidence rate of RAI after congenital heart surgery. Although the ACTH stimulation test can be used to assess adrenal function based on the hypothalamic-pituitary-adrenal axis reactivity, this approach is used primarily to assess reserve capacity of adrenal function rather than synthesis and secretion of adrenocortical hormone [ 19 , 20 ], and ethically, the ACTH stimulation test cannot verify whether RAI occurred.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Adrenal Suppression between Etomidate and Dexmedetomidine in Children with Congenital Heart Disease

Zhang

Cai

et al. 2015

Med Sci Monit

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BackgroundThe aim of this study was to compare plasma cortisol concentration during anesthesia of children with congenital heart disease who received dexmedetomidine (DEX) with those who received etomidate (ETO).Material/MethodsWe recruited 99 ASA physical status II–III pediatric patients scheduled for congenital heart disease (CHD) corrective surgery and divided into them into 3 groups. Group DEX received an infusion of DEX intravenously with a bolus dose of 0.5 μg·kg−1 within 10 min during anesthesia induction, followed by a maintenance dose of DEX 0.5 μg·kg−1·h−1. Group ETO received ETO intravenously with a bolus dose of 0.3 mg·kg−1 without a maintenance dose. Group CON received routine anesthetics as controls. The preset timepoints were: before anesthesia induction (T0), at the end of induction (T1), 30 min after anesthesia induction (T2), at the time of aortic and inferior vena catheterization (T3), and at 180 min (T4) and 24 h (T5) after anesthesia induction.ResultsThe cortisol concentration decreased gradually after anesthesia induction in all groups, and returned to baseline values after 24 h. The cortisol concentration was significantly lower in Group ETO children than in Group DEX or group CON at T4.ConclusionsThe plasma concentrations of cortisol decreased in CHD children after the operation, but returned to baseline after 24 h of anesthesia induction. The adrenal cortex function inhibition induced by ETO in CHD children is longer and more serious than that induced by DEX (if any) during the preoperative period.

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Evaluation of adrenal function in critically ill children

Cited by 15 publications

References 38 publications

Relation between Baseline Total Serum Cortisol Level and Outcome in Pediatric Intensive Care Unit

Relation between Baseline Total Serum Cortisol Level and Outcome in Pediatric Intensive Care Unit

Salivary biomarkers may measure stress responses in critically ill children

Comparison of Adrenal Suppression between Etomidate and Dexmedetomidine in Children with Congenital Heart Disease

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