Melatonin and cortisol exhibit different circadian rhythm profiles during septic shock depending on timing of onset: a prospective observational study

Sertaridou, Eleni; Chouvarda, Ioanna; Arvanitidis, Konstantinos; Filidou, Eirini; Kolios, George; Pnevmatikos, Ioannis; Papaioannou, Vasilios

doi:10.1186/s13613-018-0462-y

Cited by 18 publications

(19 citation statements)

References 49 publications

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“…Finally, it is a future challenge to transfer our exploratory findings to the bedside. However, in contrast to several studies [22,48,49], we show here that the circadian clock alterations occur early in the hospitalization, suggesting that they probably reflect the severity of inflammation. The current evidence does not really support any specific interventions, although guidelines on sedation [50] already considered this concept.…”

Section: Discussioncontrasting

confidence: 99%

Circadian disruption of core body temperature in trauma patients: a single-center retrospective observational study

et al. 2020

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Background: Circadian clock alterations were poorly reported in trauma patients, although they have a critical role in human physiology. Core body temperature is a clinical variable regulated by the circadian clock. Our objective was to identify the circadian temperature disruption in trauma patients and to determine whether these disruptions were associated with the 28-day mortality rate. Methods: A retrospective and observational single-center cohort study was conducted. All adult severe trauma patients admitted to the intensive care unit of Aix Marseille University, North Hospital, from November 2013 to February 2018, were evaluated. The variations of core body temperature for each patient were analyzed between days 2 and 3 after intensive care unit admission. Core body temperature variations were defined by three parameters: mesor, amplitude, and period. A logistic regression model was used to determine the variables influencing these three parameters. A survival analysis was performed assessing the association between core body temperature rhythm disruption and 28-day mortality rate. A post hoc subgroup analysis focused on the patients with head trauma. Results: Among the 1584 screened patients, 248 were included in this study. The period differed from 24 h in 177 (71%) patients. The mesor value (°C) was associated with body mass index and ketamine use. Amplitude (°C) was associated with ketamine use only. The 28-day mortality rate was 18%. For all trauma patients, age, body mass index, intracranial hypertension, and amplitude were independent risk factors. The patients with a mesor value < 36.9°C (p < 0.001) and an amplitude > 0.6°C (p < 0.001) had a higher 28-day mortality rate. Among the patients with head trauma, mesor and amplitude were identified as independent risk factors (HR = 0.40, 95% CI [0.23-0.70], p = 0.001 and HR = 4.73, 95% CI [1. 38-16.22], p = 0.01). Conclusions:Our results highlight an association between core body temperature circadian alteration and 28-day mortality rate. This association was more pronounced in the head trauma patients than in the non-head trauma patients. Further studies are needed to show a causal link and consider possible interventions.

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Section: Discussioncontrasting

confidence: 99%

Circadian disruption of core body temperature in trauma patients: a single-center retrospective observational study

et al. 2020

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“…Five of the 15 patients from group A and 5 from the 11 patients from group B constituting the patients’ population that we studied in our previous investigation [8] were excluded from the analyses due to fever (CBT ≥ 38.5 °C). Controls from group C included three multiple trauma patients and two subjects who underwent emergency vascular surgery for abdominal aortic aneurysm rupture.…”

Section: Resultsmentioning

confidence: 99%

“…As we described in our previous study, subjects were recruited among critically ill patients admitted to the ICU of Alexandroupolis University Hospital, Greece, between February 2015 and July 2017 [8]. The inclusion criteria were as follows: (1) patients admitted with septic shock or those who developed septic shock during their ICU stay according to the Third International Consensus Definitions for Sepsis and Septic Shock (microbiologically confirmed infection, Specific Organ Failure Assessment score (SOFA) ≥ 2, hypotension despite adequate fluid resuscitation, plus need for vasopressor administration for maintaining blood pressure ≥ 65 mmHg, plus serum lactate > 2 mmol/L) [14], (2) age > 18 and < 80 years, and (3) ICU stay more than 48 h. Exclusion criteria were as follows: (1) history of neurological disorders; (2) history of cancer, autoimmune disease, or immune-suppressive therapy; and (3) history of recent brain injury, since such cases are commonly associated with temperature deregulation [3, 9].…”

Section: Methodsmentioning

confidence: 99%

“…In a recent study, we examined the potential alterations of circadian rhythmicity of urine melatonin and cortisol excretion in critically ill patients who were admitted in the ICU with septic shock or developed septic shock during their ICU stay, in a prospective fashion and on successive occasions (septic shock and recovery) [8]. We found that septic shock induced inverse changes of melatonin and cortisol circadian rhythm profiles both within and between different groups of patients, depending on the timing of onset.…”

Section: Introductionmentioning

confidence: 99%

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Determining rhythmicity and determinism of temperature curves in septic and non-septic critically ill patients through chronobiological and recurrence quantification analysis: a pilot study

Papaioannou

Sertaridou

Chouvarda

et al. 2019

ICMx

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Background A few studies have demonstrated that critically ill patients exhibit circadian deregulation and reduced complexity of different time series, such as temperature. Results In this prospective study, we enrolled 21 patients divided into three groups: group A ( N = 10) included subjects who had septic shock at the time of ICU entry, group B ( N = 6) included patients who developed septic shock during ICU stay, and group C consisted of 5 non-septic critically ill patients. Core body temperature (CBT) was recorded for 24 h at a rate of one sample per hour (average of CBT for that hour) and during different occasions: upon ICU entry and exit in groups A and C and upon entry, septic shock development, and exit in group B. Markers of circadian rhythmicity included mean values, amplitude that is the difference between peak and mean values, and peak time. Furthermore, recurrence quantification analysis (RQA) was employed for assessing different markers of complexity of temperature signals. Patients from group C exhibited higher temperature amplitude upon entry (0.45 ± 0.19) in relation with both groups A (0.28 ± 0.18, p < 0.05) and B (0.32 ± 0.13, p < 0.05). Circadian features did not differ within all groups. Temperature amplitude in groups B and C upon entry was negatively correlated with SAPS II ( r = − 0.72 and − 0.84, p < 0.003) and APACHE II scores ( r = − 0.70 and − 0.63, p < 0.003), respectively, as well as duration of ICU and hospital stay in group B ( r = − 0.62 and − 0.64, p < 0.003) and entry SOFA score in group C ( r = − 0.82, p < 0.003). Increased periodicity of CBT was found for all patients upon exit related to entry in the ICU. Different RQA features indicating periodic patterns of change of entry CBT were negatively correlated with severity of disease and length of ICU stay for all patients. Conclusions Increased temperature rhythmicity during ICU entry was related with lower severity of disease and better clinical outcomes, whereas the more deterministic CBT patterns were found in less critically ill patients with shorter ICU stay.

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“…These studies suggest that ICU patients maintain circadian rhythms, however, these rhythms become uncoupled to the external environment. This could be due to disruptions in the signals which normally entrain the circadian clock (see below), but it could also have to do with other temporal factors such as timing of onset of a critical event (e.g., septic shock or injury time) which may uncouple the clock to the external environment (17,19,26).…”

Section: Circadian Rhythms In the Disruptive Icu Environmentmentioning

confidence: 99%

Circadian Disruption in Critical Illness

et al. 2020

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Circadian rhythms play a vital role in metabolic, hormonal, and immunologic function and are often disrupted in patients in the ICU. Circadian rhythms modulate the molecular machinery that responds to injury and illness which can impact recovery. Potential factors contributing to the alteration in circadian rhythmicity in intensive care unit (ICU) patients include abnormal lighting, noise, altered feeding schedules, extensive patient care interactions and medications. These alterations in circadian rhythms in ICU patients may affect outcomes and therefore, normalization of circadian rhythmicity in critically ill patients may be an important part of ICU care.

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Melatonin and cortisol exhibit different circadian rhythm profiles during septic shock depending on timing of onset: a prospective observational study

Cited by 18 publications

References 49 publications

Circadian disruption of core body temperature in trauma patients: a single-center retrospective observational study

Circadian disruption of core body temperature in trauma patients: a single-center retrospective observational study

Determining rhythmicity and determinism of temperature curves in septic and non-septic critically ill patients through chronobiological and recurrence quantification analysis: a pilot study

Circadian Disruption in Critical Illness

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