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

Bekhit, Osama E.; Mohamed, Shereen A.; Yousef, Remon M.; AbdelRasol, Hoiyda A.; Khalaf, Nirvana A.; Salah, F.

doi:10.1038/s41598-019-42443-z

Cited by 6 publications

(10 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, socioeconomic factors affected discharge decisions, with considerations such as transportation and caregiver availability playing significant roles. [8][9][10][11][12][13][14][15] Most of the studies confirm our findings.…”

Section: Discussionsupporting

confidence: 85%

Serum Cortisol Levels in Children with Catecholamine-Dependent Shock – A Prospective Observational Study

et al. 2024

Int. J. Res. Pharm. Sci.

View full text Add to dashboard Cite

Pediatric septic shock poses a significant challenge in ICUs worldwide, with high mortality and morbidity rates despite medical advancements. Early recognition and aggressive management are crucial. Resistance to standard therapies in some cases suggests potential adrenal insufficiency, particularly relative adrenal insufficiency (RAI), though research is limited. This study aimed to assess adrenal insufficiency prevalence in pediatric septic shock by evaluating basal serum cortisol levels in 49 children aged 1 month to 12 years admitted to the PICU. Results showed a significant 41% prevalence of adrenal insufficiency, correlating with prolonged critical care needs. Despite increased interventions, mortality rates didn't notably differ between groups. Recognition of adrenal insufficiency is vital due to its association with extended critical care requirements. Further research, including stimulation tests and trials, is needed to distinguish absolute and relative adrenal insufficiency and assess potential benefits of steroid supplementation. This study underscores the importance of comprehensive management strategies incorporating adrenal function assessment in improving outcomes for critically ill children with septic shock.

show abstract

Section: Discussionsupporting

confidence: 85%

Serum Cortisol Levels in Children with Catecholamine-Dependent Shock – A Prospective Observational Study

et al. 2024

Int. J. Res. Pharm. Sci.

View full text Add to dashboard Cite

show abstract

“…These findings suggest that basal cortisol levels are associated with the severity of the initial stressor and that insufficient adrenal reserve and a diminished HPA response to this severe stress result in a grave prognosis. Similar results have been shown in critically ill adults and children, reporting that high basal serum cortisol levels are associated with increased mortality [8][9][10][11].…”

Section: Discussionsupporting

confidence: 82%

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

Kim

Lee

et al. 2020

Acute Crit Care

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

“…In septic shock patients, 11.8% were diagnosed with CIRCI, but it was the non-CIRCI patients who had higher SOFA scores and 28-day mortality (26). In a prospective cohort of PICU patients, although CIRCI was prevalent it was not associated with an increased mortality rate (34). Furthermore, in a systematic review by Rezai et al (35) in children and adolescents, circulating cortisol levels during acute illness were higher than in controls, indicating an association with disease severity.…”

Section: Discussionmentioning

confidence: 99%

Cortisol Levels During First Admission Day Are Associated With Clinical Outcomes in Surgical Critically Ill Patients

Goder,

Gerstenhaber,

Gal Oz

et al. 2024

Critical Care Explorations

View full text Add to dashboard Cite

IMPORTANCE: To explore the correlation between cortisol levels during first admission day and clinical outcomes. OBJECTIVES: Although most patients exhibit a surge in cortisol levels in response to stress, some suffer from critical illness-related corticosteroid insufficiency (CIRCI). Literature remains inconclusive as to which of these patients are at greater risk of poor outcomes. DESIGN: A retrospective study. SETTING: A surgical ICU (SICU) in a tertiary medical center. PARTICIPANTS: Critically ill patients admitted to the SICU who were not treated with steroids. MAIN OUTCOMES AND MEASURES: Levels of cortisol taken within 24 hours of admission (day 1 [D1] cortisol) in 1412 eligible patients were collected and analyzed. Results were categorized into four groups: low (0–10 µg/dL), normal (10–25 µg/dL), high (25–50 µg/dL), and very high (above 50 µg/dL) cortisol levels. Primary endpoint was 90-day mortality. Secondary endpoints were the need for organ support (use of vasopressors and mechanical ventilation [MV]), ICU length of stay (LOS), and duration of MV. RESULTS: The majority of patients (63%) had high or very high D1 cortisol levels, whereas 7.6% had low levels and thus could be diagnosed with CIRCI. There were statistically significant differences in 90-day mortality between the four groups and very high levels were found to be an independent risk factor for mortality, primarily in patients with Sequential Organ Failure Assessment (SOFA) less than or equal to 3 or SOFA greater than or equal to 7. Higher cortisol levels were associated with all secondary endpoints. CIRCI was associated with favorable outcomes. CONCLUSIONS AND RELEVANCE: In critically ill surgical patients D1 cortisol levels above 50 mcg/dL were associated with mortality, need for organ support, longer ICU LOS, and duration of MV, whereas low levels correlated with good clinical outcomes even though untreated. D1 cortisol level greater than 50 mcg/dL can help discriminate nonsurvivors from survivors when SOFA less than or equal to 3 or SOFA greater than or equal to 7.

show abstract

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

Cited by 6 publications

References 24 publications

Serum Cortisol Levels in Children with Catecholamine-Dependent Shock – A Prospective Observational Study

Serum Cortisol Levels in Children with Catecholamine-Dependent Shock – A Prospective Observational Study

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

Cortisol Levels During First Admission Day Are Associated With Clinical Outcomes in Surgical Critically Ill Patients

Contact Info

Product

Resources

About