Prognostic Implication of Adrenocortical Response during the Course of Critical Illness

Background: Previous trials evaluated the incidence of critical illness-related corticosteroid insufficiency (CIRCI) using 250 μg adrenocorticotropic hormone (ACTH). However, this supraphysiological dose could result in false-positive levels. We aimed to determine the incidence of CIRCI in septic patients using a 1 μg ACTH stress test. Methods: We conducted a prospective cohort study on 39 patients with septic shock. Critical illness-related corticosteroid insufficiency was defined as a Δ max cortisol <9 μg/dL after 1 μg ACTH stress test. The primary outcome of the study was death. Secondary outcomes included days of vasopressors, days of mechanical ventilation (MV), amount of fluid per day, the incidence of acute kidney injury (AKI), and days of intensive care unit (ICU) stay. Results: The incidence of CIRCI in our cohort was 43.6% using 1 μg ACTH. There were no significant differences between groups in terms of ICU scores, laboratory investigations, vasopressors, MV days, amount of fluid per day, and the ICU stay ( P = > 0.05). The CIRCI group had lower median survival and survival probability rates (5 days and 48.4%, respectively) compared with the non-CIRCI group (7 days and 49.5%, respectively). In addition, the CIRCI group had a shorter time to develop AKI and a higher probability of developing AKI (4 days and 44.6%, respectively) in comparison with the non-CIRCI group (6 days and 45.57%, respectively). Conclusion: We concluded that the CIRCI group had a lower mean survival rate and a higher incidence of AKI. We recommend the use of 1 μg ACTH test in septic shock patients to identify this subgroup of patients.

show abstract

“…As previously reported (23), the CIRCI group had significantly lower cortisol levels than the non-CIRCI group.…”

Section: Discussionsupporting

confidence: 87%

“…de Jong et al (36) found significantly lower hospital stay in patients without CIRCI. On the contrary, most other studies showed an insignificant difference (20,22,23). These contradictory results could be attributable to the characteristics of the cohort.…”

Section: Discussionmentioning

confidence: 78%

Prognostic Value of Low-Dose Adrenocorticotropic Hormone Test in Critically Ill Patients

Abdelrehim

Mohsen

Haredi

et al. 2023

Shock

View full text Add to dashboard Cite

show abstract

“…More than half of our mechanically ventilated patients had CIRCI, and the presence of CIRCI was not associated with increased mortality. Other studies have also shown that the presence of CIRCI does not affect the outcome of critically ill patients [ 20 - 22 ]. Another interesting finding of this study was that that delta salivary cortisol, but not the delta serum cortisol, was significantly higher in survivors than in non-survivors.…”

Section: Discussionmentioning

confidence: 99%

Comparison of salivary and serum cortisol levels in mechanically ventilated patients and non-critically ill patients

Kim

Lee

et al. 2020

Acute Crit Care

Self Cite

View full text Add to dashboard Cite

Comparison of salivary and serum cortisol levels in mechanically ventilated patients and non-critically ill patients Background: Although the measuring free cortisol is ideal for assessment of hypothalamicpituitary-adrenal function, it is not routinely measured. Salivary cortisol correlates well with the biologically active free cortisol. Therefore, this study measured the morning basal as well as adrenocorticotropic hormone-stimulated salivary cortisol levels in mechanically ventilated patients and compared the results with non-critically ill patients. Methods: We prospectively enrolled 49 mechanically ventilated patients and 120 patients from the outpatient clinic. Serum and saliva samples were collected between 8 AM and 10 AM. Salivary cortisol levels were measured using an enzyme immunoassay kit. The salivary samples were insufficient in 15 mechanically ventilated patients (30.6%), and these patients were excluded from the final analysis. Results: Mechanically ventilated patients (n = 34) were significantly older and had lower body mass index and serum albumin levels and higher serum creatinine levels than non-critically ill patients (n = 120). After adjustment for these parameters, both basal and stimulated salivary and serum cortisol levels were higher in mechanically ventilated patients. The increase in cortisol was not significantly different between the two groups. Serum cortisol levels showed a positive correlation with salivary cortisol levels. Among mechanically ventilated patients, both basal serum and salivary cortisol levels were lower in survivors than in non-survivors. Conclusions: Both basal total serum and salivary cortisol levels were elevated in mechanically ventilated patients and in non-survivors.

show abstract

“…Assumed mechanisms involve decreased hepatic inactivation, decreased renal excretion, lower levels of cortisol binding globulin, increased levels of bile acids or direct stimulation of cortisol synthesis, and release by inflammatory cytokines [34]. Also, it has been demonstrated that ACTH/cortisol dissociation has a negative impact on prognosis [33][34][35]. As glucocorticoids suppress AVP secretion, this hypercortisolemic state during critical illness might be a reason for the lower copeptin levels at day 3 in non-survivors.…”

Section: Plos Onementioning

confidence: 99%

Copeptin and stress-induced hyperglycemia in critically ill patients: A prospective study

et al. 2021

View full text Add to dashboard Cite

Objectives Copeptin, an equimolar indicator of serum antidiuretic hormone levels, has been associated with higher mortality in critically ill patients and with the development of diabetes in the general population. The aim of the present study was to investigate the association of copeptin levels with glycemic parameters in critically ill patients and to compare the time-course of copeptin in survivors and non-survivors. Design Prospective cohort study. Patients From June to October 2019, critically ill patients were prospectively enrolled and followed for 90 days. Measurements Plasma copeptin levels were determined at intensive care unit (ICU) admission (copeptin T1), 24 h (copeptin T2), and 48 h (copeptin T3) after study entry. Blood glucose and glycated hemoglobin levels were measured. ICU, in-hospital, and 90-day mortality, and length of stay in the ICU and hospital were evaluated. Results 104 patients were included. No significant correlation was detected between copeptin levels and blood glucose (r = -0.17, p = 0.09), HbA1c (r = 0.01, p = 0.9), glycemic gap (r = -0.16, p = 0.11), and stress hyperglycemia ratio (r = -0.14, p = 0.16). Copeptin T3 levels were significantly higher in survivors than in non-survivors at hospital discharge (561 [370–856] vs 300 [231–693] pg/mL, p = 0.015) and at 90 days (571 [380–884] vs 300 [232–698] pg/mL, p = 0.03). Conclusions No significant correlations were found between copeptin levels and glycemic parameters, suggesting that copeptin is not a relevant factor in the induction of hyperglycemia during critical illness. Copeptin levels at ICU day 3 were higher in survivors than in non-survivors.

show abstract

Prognostic Implication of Adrenocortical Response during the Course of Critical Illness

Cited by 8 publications

References 15 publications

Prognostic Value of Low-Dose Adrenocorticotropic Hormone Test in Critically Ill Patients

Prognostic Value of Low-Dose Adrenocorticotropic Hormone Test in Critically Ill Patients

Comparison of salivary and serum cortisol levels in mechanically ventilated patients and non-critically ill patients

Copeptin and stress-induced hyperglycemia in critically ill patients: A prospective study

Contact Info

Product

Resources

About