Neuroendocrine Derangements in Early Septic Shock

Schurr, James W.; Szumita, Paul M.; DeGrado, Jeremy

doi:10.1097/shk.0000000000000864

Cited by 8 publications

(3 citation statements)

References 111 publications

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“…Often, a drop in blood pressure during shock indicates that the shock has entered a decompensated period. At this stage, the inflammatory response is severe, which seriously affects the metabolism of endocrine hormones, such as thyroid hormones (27). Therefore, blood pressure is one of the risk factors related to ESS.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Incidence of Euthyroid Sick Syndrome in Comprehensive Intensive Care Units and Related Risk Factors

et al. 2021

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ObjectiveA low concentration of plasma triiodothyronine (T3) indicates euthyroid sick syndrome (ESS), which could be associated with a poor outcome in patients in intensive care units (ICUs). This study evaluated the relationship between ESS and prognostic indicators in patients admitted to an ICU and examined the free T3 (FT3) cut-off points that could be associated with 28-day mortality.MethodsThis prospective observational study included patients admitted to the ICU of The Third Hospital of Hebei Medical University between February and November 2018. Baseline variables and data on the occurrence of low FT3 were collected. The patients were divided into ESS (FT3 < 3.28 pmol/L) and non-ESS groups. The relationship between ESS and prognostic indicators in patients admitted to the ICU was evaluated, and the FT3 cut-off points that could be associated with 28-day mortality were examined.ResultsOut of a total of 305 patients, 118 (38.7%) were in the ESS group. Levels of FT3 (P < 0.001) and FT4 (P = 0.001) were lower, while the 28-day mortality rate (P < 0.001) and hospitalization expenses in the ICU (P = 0.001) were higher in the ESS group. A univariable analysis identified ESS, FT3, free thyroxine (FT4)/FT3, the APACHE II score, the sequential organ failure (SOFA) score, the duration of mechanical ventilation, creatinine (CREA) levels, the oxygenation index (HGB), white blood cells, albumin (ALB) levels, age, and brain natriuretic peptide (BNP) levels as factors associated with 28-day mortality (all P < 0.05). The cut-off value of FT3 for 28-day mortality was 2.88 pmol/L, and the 28-day mortality rate and hospitalization expenses in the ICU were higher in patients with ESS. The syndrome was confirmed to be independently associated with 28-day mortality.ConclusionThis study determined the incidence of ESS in the comprehensive ICU to be 38.7%. APACHE II, SOFA, BNP, APTT, HGB, PLT, CREA, ALB, FT4, SBP, and DBP are closely related to ESS, while BNP, PLT, and ALB are independent risk factors for the syndrome.

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Section: Discussionmentioning

confidence: 99%

Analysis of the Incidence of Euthyroid Sick Syndrome in Comprehensive Intensive Care Units and Related Risk Factors

et al. 2021

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“…Several possible biological explanations exist for these interactions, including VP binding to V1b receptors in the anterior pituitary, leading to adrenocorticotropin hormone release 41 . On the other hand, corticosteroids restore cytokine-mediated down-regulation of VP receptors 42 . This suggests a regulatory interdependence between VP and cortisol secretion when VP stimulates corticotropin production in the setting of relative adrenal insufficiency 43 .…”

Section: Discussionmentioning

confidence: 99%

The order of vasopressor discontinuation and incidence of hypotension: a retrospective cohort analysis

Xuan

Evans

et al. 2021

Sci Rep

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The optimal order of vasopressor discontinuation during shock resolution remains unclear. We evaluated the incidence of hypotension in patients receiving concomitant vasopressin (VP) and norepinephrine (NE) based on the order of their discontinuation. In this retrospective cohort study, consecutive patients receiving concomitant VP and NE infusions for shock admitted to intensive care units were evaluated. The primary outcome was hypotension incidence following discontinuation of VP or NE (VP1 and NE1 groups, respectively). Secondary outcomes included the incidence of acute kidney injury (AKI) and arrhythmias. Subgroup analysis was conducted by examining outcomes based on the type of shock. Of the 2,035 included patients, 952 (46.8%) were VP1 and 1,083 (53.2%) were NE1. VP1 had a higher incidence of hypotension than NE1 (42.1% vs. 14.2%; P < 0.001), longer time to shock reversal (median: 2.5 vs. 2.2 days; P = .009), higher hospital [29% (278/952) vs. 24% (258/1083); P = .006], and 28-day mortality [37% (348/952) vs. 29% (317/1,083); P < 0.001] when compared with the NE1 group. There were no differences in ICU mortality, ICU and hospital length of stay, new-onset arrhythmia, or AKI incidence between the two groups. In subgroup analyses based on different types of shock, similar outcomes were observed. After adjustments, hypotension in the following 24 h and 28-day mortality were significantly higher in VP1 (Odds ratios (OR) 4.08(3.28, 5.07); p-value < .001 and 1.27(1.04, 1.55); p-value < .001, respectively). Besides, in a multivariable model, the need for renal replacement therapy (OR 1.68 (1.34, 2.12); p-value < .001) was significantly higher in VP1. Among patients with shock who received concomitant VP and NE, the VP1 group was associated with a higher incidence of hypotension in comparison with NE1. Future studies need to validate our findings and their impact on clinical outcomes.

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“…In a significant percentage of patients, the neuroendocrine response is heralded by initial high levels of cortisol and vasopressin with a subsequent relative insufficiency of both in a significant percentage of patients. This pattern requires consideration both for understanding of pathobiology of sepsis and guiding treatment decisions (71).…”

Section: Molecular Biology and Pathophysiologymentioning

confidence: 99%

50 Years of Sepsis Investigation/Enlightenment Among Adults—The Long and Winding Road

Dellinger

Levy

Schorr

et al. 2021

Critical Care Medicine

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Neuroendocrine Derangements in Early Septic Shock

Cited by 8 publications

References 111 publications

Analysis of the Incidence of Euthyroid Sick Syndrome in Comprehensive Intensive Care Units and Related Risk Factors

Analysis of the Incidence of Euthyroid Sick Syndrome in Comprehensive Intensive Care Units and Related Risk Factors

The order of vasopressor discontinuation and incidence of hypotension: a retrospective cohort analysis

50 Years of Sepsis Investigation/Enlightenment Among Adults—The Long and Winding Road

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