Serum cortisol level and adrenal reserve as a predictor of patients’ outcome after successful cardiopulmonary resuscitation

Abstract

Introduction: It is thought that pituitary-adrenal axis has a fundamental role in outcome of cardiopulmonary arrest (CPA). This study designed to evaluate the correlation between adrenal reserve and post-resuscitation outcome. Methods: In this clinical trial study, 52 consecutive patients with CPA were enrolled in two emergency departments (EDs) over a 3-month period. Plasma cortisol level was measured at the beginning of CPR. Intravenous adrenocorticotropic hormone (ACTH) stimulation test was carried out after successful CPR, and blood samples were taken at 30 and 60 minutes, and 24 hours thereafter. Patients were divided into two groups: in-hospital death or hospital discharge. Results: In patients who died, baseline and post-ACTH serum cortisol after 30 and 60 minutes and 24 hours were higher than patients who discharged from the hospital, but it was not statistically significant except to that of minute 60 (P=0.49). A model of multivariate logistic regression analysis showed that age and need for vasopressor infusion correlated with mortality. Conclusion: Current study could not show the statistically significant difference in initial and post-ACTH serum cortisol levels between survivor and non-survivor patients with cardiac arrest who had initial successful CPR, except to that of minute 60.

A characterization of cortisol level and adrenal reservation in human cardiopulmonary arrest: systematic review and meta-analysis

“…Although we tried to explore all the studies in this field, only five studies met the inclusion criteria for meta-analysis. In three of these studies, non-survivors of CPA not only did have low baseline cortisol levels, but the patients' cortisol levels were even higher than normal [1,11,19]. Simultaneously, two clinical studies aligned to the results of this meta-analysis suggested a lower baseline cortisol level in non-survivors of CPA [17,18].…”

“…The designs of the included studies were highly heterogeneous. All of the included studies were cohort [1,11,[17][18][19]. All studies were published from 2004 and 2016.…”

“…The only common parameter in all the studies was baseline serum cortisol level. This parameter was higher in survivors than in the non-survivors in two of the studies [17,18], while the levels were higher in non-survivors in the other three studies [1,11,19]. Table 1 represents the characteristics of the included articles.…”

The evaluation of pituitary damage associated with cardiac arrest: An experimental rodent model

“…Stress-induced HPA-axis activity and concomitant inflammatory responses are of great importance in resuscitation science, and there is abundant clinical evidence supporting its significance in the pathophysiology of post-CA syndrome [35][36][37][38][39] . ACTH (pars distalis hormone) and cortisol levels were measured in the plasma samples.…”

Expression of Glucocorticoid Receptors in the Early Period After the Return of Spontaneous Circulation Among Patients Who Experienced Cardiac Arrest : A Retrospective Observational Study

“…CA is the most intense among acute stress events, which seriously affects the function of the pituitary and adrenal axis [8]. Studies have shown that abnormal cortisol levels and relative adrenocortical insu ciency after ROSC in patients who experienced CA are related to their prognosis [8][9][10][11][12]. However, the clinical application of glucocorticoids (GCs) is controversial.…”