Insuficiência adrenal relativa no choque séptico: comparação da resposta ao tratamento com hidrocortisona em pacientes diagnosticados através de dosagem única do cortisol plasmático versus teste da corticotropina

Azevedo, José Raimundo A. de; Azevedo, Renato Palácio de; Cossetti, Rachel Jorge Dino; Lima, Eduardo Rodrigues M.; Sousa, Gescirene Borges de

doi:10.1590/s0103-507x2008000100003

Cited by 3 publications

(5 citation statements)

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“…Of these 185, 15 were initially classified as randomized clinical trials. (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) These 15 original articles were analyzed regarding concealment of allocation, and six articles (17,(19)(20)(21)(22)(23) (40%) ranked as A, other six articles (10,(13)(14)(15)(16)18) (40%) ranked as B, two articles (11,12) (13.3%) as C and one article (9) (6.7%) that was not a randomized clinical trial was ranked as D.…”

Section: Resultsmentioning

confidence: 99%

“…Results of the quality assessment disclosed that 7% (1/13) of the articles were of good quality (22) (Table 1). Score distribution on the quality scale was: zero for 8 (57.2%) original articles (10)(11)(12)(13)(14)(15)(16)18) 2 points for 5 (35.7%) (17,(19)(20)(21)23) and 4 points for one (7.1%) original article that presented good methodological quality. (22) The assessment of the secondary variables of all original articles showed that: 110 (59.5%) original articles described submitting the project to a Committee of Ethics in Research, 53 (28.6%) described use of informed consent, 19 (10.3%) described sample size calculation, 146 (78.9%) described the variables analyzed, 118 (63.8%) described inclusion criteria, 90 (48.6%) described exclusion criteria and in only 3 (1.6%) was there a description of the funding source.…”

Section: Resultsmentioning

confidence: 99%

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Avaliação da qualidade dos ensaios clínicos aleatórios em terapia intensiva

Gonçalves¹,

Barbosa²,

Barbosa³

et al. 2009

Rev. bras. ter. intensiva

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Objective: A randomized clinical trial is a prospective study that compares the effect and value of interventions in human beings, of one or more groups vs. a control group. The objective of this study was to evaluate the quality of published randomized clinical trials in Intensive care in Brazil. Methods: All randomized clinical trials in intensive care found by manual search in Revista Brasileira de Terapia Intensiva from January 2001 to March 2008 were assessed to evaluate their description by the quality scale. Descriptive statistics and a 95 % confidence interval were used for the primary outcome. Our primary outcome was the randomized clinical trial quality. Results: Our search found 185 original articles, of which 14 were randomized clinical trials. Only one original article (7.1%) showed good quality. There was no statistical significance between the collected data and the data shown in the hypothesis of this search. Conclusion: It can be concluded that in the sample of assessed articles 7% of the randomized clinical trials in intensive care published in a single intensive care journal in Brazil, present good methodological quality.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Avaliação da qualidade dos ensaios clínicos aleatórios em terapia intensiva

Gonçalves¹,

Barbosa²,

Barbosa³

et al. 2009

Rev. bras. ter. intensiva

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“…(7-9,11,19,24-27) However, this finding is still controversial, especially in the aftermath of the publication of the CORTICUS study, which raised doubts about the utility of the ACTH test and even the beneficial effect of low-dose hydrocortisone in severe sepsis. (28) Although CIRCI is recognized as a dysfunction, (5,15) different trials have shown different results about the treatment of this dysfunction.…”

Section: Introductionmentioning

confidence: 99%

“…( 2 , 16 , 17 ) Baseline cortisol levels alone could also be used to help identify CIRCI; however, no trials could identify a baseline cortisol cutoff point that could be used to diagnose CIRCI or guide therapy. ( 2 , 18 , 19 ) In the course of severe disease, low levels of cortisol-binding proteins and hypoalbuminemia may lower total cortisol levels and responses to ACTH independently of free cortisol levels and in the absence of CIRCI. ( 20 - 22 ) However, the measurement of free cortisol (biologically active) in serum or saliva is not widely available and requires further studies in critical care patients.…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, in several studies, hydrocortisone substitution therapy may have had beneficial effects on the hemodynamics and outcome of patients with severe septic shock needing vasopressor/inotropic treatment, particularly when associated with a diminished ACTH response. ( 7 - 9 , 11 , 19 , 24 - 27 ) However, this finding is still controversial, especially in the aftermath of the publication of the CORTICUS study, which raised doubts about the utility of the ACTH test and even the beneficial effect of low-dose hydrocortisone in severe sepsis. ( 28 ) Although CIRCI is recognized as a dysfunction, ( 5 , 15 ) different trials have shown different results about the treatment of this dysfunction.…”

Section: Introductionmentioning

confidence: 99%

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Insuficiência adrenal relativa como preditora de gravidade de doença e mortalidade do choque séptico

Dalegrave¹,

Silva²,

Becker³

et al. 2012

Rev. bras. ter. intensiva

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ObjectiveTo evaluate if cortisol responses to 250 µg of intravenously administered adrenocorticotropic hormone are related to disease severity and, hence, mortality. MethodsThis is a retrospective study in a medical-surgical intensive care unit of a university hospital. We studied 69 consecutive patients with septic shock over a 1-yr period; these patients underwent a short 250-µg adrenocorticotropic hormone test because they exhibited >6 hours of progressive hemodynamic instability requiring repeated fluid challenges and vasopressor treatment to maintain blood pressure. The test was performed by intravenously injecting 250 µg of synthetic adrenocorticotropic hormone and measuring cortisol immediately before injection, 30 minutes post-injection and 60 minutes post-injection. ResultsThe mean APACHE II score was 22±7. The intensive care unit mortality rate at day 28 was 55%. Median baseline cortisol levels (19 [11-27] µg/dL versus 24 [18-34] µg/dL, p=0.047) and median baseline cortisol/albumin ratios (7.6 [4.6-12.3] versus 13.9 [8.8-18.5]; p=0.01) were lower in survivors than in non-survivors. Responders and non-responders had similar baseline clinical data and outcomes. The variables that were significantly correlated with outcome based on the area under the ROC curves (AUC) were APACHE II (AUC=0.67 [0.535 to 0.781]), baseline cortisol (µg/dl) (AUC=0.662 [0.536 to 0.773], peak cortisol (µg/dl) (AUC=0.642 [0.515 to 0.755]) and baseline cortisol/albumin (AUC=0.75 [0.621 to 0.849]). ConclusionsIncreased basal cortisol is associated with mortality and disease severity. Cortisol responses upon adrenocorticotropic hormone stimulation were not related to outcome. The cortisol/albumin ratio does not predict unfavorable outcomes better than total cortisol levels or help to improve the accuracy of the adrenocorticotropic hormone test.

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