Year in review 2009: Critical Care - metabolism

Huberlant, Vincent; Preiser, Jean‐Charles

doi:10.1186/cc9256

Cited by 29 publications

(40 citation statements)

References 44 publications

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“…After centrifugation, aliquots of the samples were immediately stored at −80°C before assay. Serum cortisol concentration was measured with a solid-phase, competitive chemiluminescent enzyme immunoassay in a calibrated IMMULITE 2000 analyzer (Diagnostic Products Corporation, Los Angeles, CA, USA).The normal range of morning serum cortisol concentration in our hospital laboratory is 145 to 650 nmol/L, which is broadly the same as that of other laboratories (201–681 nmol/L [21], 138–690 nmol/L [22], 119–618 nmol/L [12]). The detection limit was 5 nmol/L.…”

Section: Methodsmentioning

confidence: 56%

Cortisol as a Prognostic Marker of Short-Term Outcome in Chinese Patients with Acute Ischemic Stroke

Shuai

2013

PLoS ONE

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BackgroundEarly prediction of outcome is important for allocation of therapeutic strategies. Endocrine alterations of the hypothalamus–pituitary–axis are one of the first stress-induced alterations after cerebral ischemia. We therefore evaluated the prognostic value of serum cortisol in Chinese patients with an acute ischemic stroke.MethodsIn a prospective observational study, serum cortisol was measured using a solid-phase, competitive chemiluminescent enzyme immunoassay on admission in serum of 226 consecutive Chinese patients with an acute ischemic stroke. The prognostic value of serum cortisol to predict the functional outcome, mortality within 90 days, was compared with clinical variables (e.g., advanced age and the National Institutes of Health Stroke Scale [NHISS] score) and with other known predictors.ResultsPatients with a poor outcome and nonsurvivors had significantly increased serum cortisol levels on admission (P<0.0001, P<0.0001). There was a positive correlation between levels of cortisol and the NIHSS (r = 0.298, P<0.0001), glucose levels (r = 0.324, P<0.0001) and infarct volume (r = 0.328, P<0.0001). Cortisol was an independent prognostic marker of functional outcome and death [odds ratio 3.44 (2.58–6.23) and 4.21 (1.89–9.24), respectively, P<0.0001 for both, adjusted for age, the NIHSS and other predictors] in patients with ischemic stroke. In receiver operating characteristic curve analysis, cortisol could improve the NIHSS score in predicting short-term functional outcome (Area under the curve [AUC] of the combined model, 0.87; 95% CI, 0.82–0.92; P = 0.01) and mortality (AUC of the combined model, 0.90; 95% CI, 0.84–0.95; P = 0.01).ConclusionCortisol can be seen as an independent short-term prognostic marker of functional outcome and death in Chinese patients with acute ischemic stroke even after correcting confounding factors. Combined model can add significant additional predictive information to the clinical score of the NIHSS.

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Section: Methodsmentioning

confidence: 56%

Cortisol as a Prognostic Marker of Short-Term Outcome in Chinese Patients with Acute Ischemic Stroke

Shuai

2013

PLoS ONE

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“…This prospective cohort study is continued from our previous ones [14,15]. The data of 103 patients who completed both serum cortisol measurement and perioperative neuropsychological tests during the previous studies were included in the final analyses of this paper.…”

Section: Methodsmentioning

confidence: 99%

“…Serum cortisol concentration was measured with a solid-phase, competitive chemiluminescent enzyme immunoassay in a calibrated Immulite 1000 analyzer (Diagnostic Products Corporation, Los Angeles, CA, USA) as in our previous study [14]. The intra-assay and inter-assay coefficients of variation were less than 5.6% and 8.2%, respectively.…”

Section: Methodsmentioning

confidence: 99%

High Postoperative Serum Cortisol Level Is Associated with Increased Risk of Cognitive Dysfunction Early after Coronary Artery Bypass Graft Surgery: A Prospective Cohort Study

Wang

et al. 2013

PLoS ONE

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ContextStress response induced by surgery is proposed to play an important role in the pathogenesis of postoperative cognitive dysfunction.ObjectiveTo investigate the association between postoperative serum cortisol level and occurrence of cognitive dysfunction early after coronary artery bypass graft surgery.DesignProspective cohort study.SettingTwo teaching hospitals.PatientsOne hundred and sixth-six adult patients who were referred to elective coronary artery bypass graft surgery from March 2008 to December 2009.InterventionNone.Main Outcome MeasuresNeuropsychological tests were completed one day before and seven days after surgery. Cognitive dysfunction was defined using the same definition as used in the ISPOCD1-study. Blood samples were obtained in the first postoperative morning for measurement of serum cortisol concentration. Multivariate Logistic regression analyses were performed to assess the relationship between serum cortisol level and occurrence of postoperative cognitive dysfunction.ResultsCognitive dysfunction occurred in 39.8% (66 of 166) of patients seven days after surgery. Multivariate Logistic regression analysis showed that high serum cortisol level was significantly associated with the occurrence of postoperative cognitive dysfunction (odds ratio [OR] 2.603, 95% confidence interval [CI] 1.371-4.944, P = 0.003). Other independent predictors of early postoperative cognitive dysfunction included high preoperative New York Heart Association functional class (OR 0.402, 95% CI 0.207-0.782, P = 0.007), poor preoperative Grooved Pegboard test score of nondominant hand (OR 1.022, 95% CI 1.003-1.040, P = 0.020), use of penehyclidine as premedication (OR 2.565, 95% CI 1.109-5.933, P = 0.028), and occurrence of complications within seven days after surgery (OR 2.677, 95% CI 1.201-5.963, P = 0.016).ConclusionsHigh serum cortisol level in the first postoperative morning was associated with increased risk of cognitive dysfunction seven days after coronary artery bypass graft surgery.

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“…Furthermore, there were strong positive correlations in day-by-day comparisons (P<0.001); therefore, we believe that CGMS glucose values are relatively accurate and reliable and can be used in STEMI patients undergoing p-PCI. Stress hyperglycemia is the result of sympathetic nervous system activation and increased production of catecholamines and cortisol that stimulate the processes of glyconeogenesis, glycogenolysis and lipolysis [33,34]. Goyal et al Data are reported as the mean ± SD or n (%).…”

Section: Discussionmentioning

confidence: 99%

Feasibility and safety of continuous glucose monitoring systems in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions

Zhang¹,

Ling²,

Cao³

et al. 2015

CIM

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Feasibility and safety of continuous glucose monitoring systems in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions AbstractPurpose: The purpose of this study was to evaluate the feasibility and safety of continuous glucose monitoring systems (CGMS) in ST segment elevation myocardial infarction (S-TEMI) patients undergoing primary percutaneous coronary interventions (p-PCI) in coronary care units (CCU).Methods: CGMS was performed for 3 days during CCU hospitalization for each of the subjects. The correlation between glucose values, recorded with CGMS, and finger-stick capillary glucose values was examined. The parameters and safety of CGMS were also investigated.Results: Data from 219 subjects were included in the statistical analysis. Correlation analysis showed a strong positive correlation between interstitial glucose values recorded by CGMS and the corresponding capillary glucose values (P<0.001). The daytime mean blood glucose MBG), the nighttime MBG and PT7.8 were the highest in the first day of CGMS compared with the second and third day. Furthermore, there were no indications of major hemorrhage or hematoma at the site of sensor insertion. Any adverse events were mild.Conclusions: CGMS glucose values are relatively accurate and reliable. CGMS were safe and can be used as a tool to detect trends in glucose levels and to predict upcoming glucose excursions in STEMI patients undergoing p-PCI. It is commonly accepted that continuous glucose monitoring systems (CGMS) can provide detailed and accurate glucose information. Relaying this detailed glucose information to patients has been shown to have a positive influence on glycemic control, including reductions in glucose variability, time spent in nocturnal hypoglycemia, time spent in hyperglycemia and levels of glycosylated hemoglobin [1][2][3][4]. Hyperglycemia commonly occurs during acute myocardial infarction (AMI), and in-hospital hyperglycemia is a strong predictor of mortality in AMI patients both with and without a history of diabetes mellitus [5][6]. The adverse outcomes associated with in-hospital hyperglycemia have prompted professional societies to recommend glucose control in AMI patients [5][6][7]; however, implementation of glucose control has been hindered by fear of hypoglycemia, as low glucose levels have been associated with adverse outcomes in AMI patients [8][9]. Patients with STsegment elevation myocardial infarction (STEMI) who are undergoing primary percutaneous coronary interventions (p-PCI) should receive aggressive management and treatment in coronary care units (CCU). As glucose management is a significant component of CCU activity, CGMS are particularly attractive for managing blood glucose (BG) because of their potential to detect hypo-and hyperglycemia as they occur. Many studies have concluded that CGMS face challenges in terms of sensitivity, stability, calibration and the physiological delay between BG and interstitial glucose (IG) concentration [10][11][12]. Moreover, CGMS are more e...

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Year in review 2009: Critical Care - metabolism

Cited by 29 publications

References 44 publications

Cortisol as a Prognostic Marker of Short-Term Outcome in Chinese Patients with Acute Ischemic Stroke

Cortisol as a Prognostic Marker of Short-Term Outcome in Chinese Patients with Acute Ischemic Stroke

High Postoperative Serum Cortisol Level Is Associated with Increased Risk of Cognitive Dysfunction Early after Coronary Artery Bypass Graft Surgery: A Prospective Cohort Study

Feasibility and safety of continuous glucose monitoring systems in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions

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