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01-12-2007 | Original

A prospective study on adrenal cortex responses and outcome prediction in acute critical illness: results from a large cohort of 203 mixed ICU patients

Authors: Ioanna Dimopoulou, Konstantinos Stamoulis, Ioannis Ilias, Marinella Tzanela, Panagiotis Lyberopoulos, Stylianos Orfanos, Apostolos Armaganidis, Maria Theodorakopoulou, Stylianos Tsagarakis

Published in: Intensive Care Medicine | Issue 12/2007

Abstract

Objective

To assess whether adrenal cortex hormones predict ICU mortality in acute, mixed, critically ill patients.

Design and setting

Prospective study in consecutive intensive care patients in the general ICU of a teaching hospital.

Patients

203 severely ill patients with multiple trauma (n = 93), medical (n = 57), or surgical (n = 53) critical states.

Measurements and results

Within 24 h of admission in the ICU a morning blood sample was obtained to measure baseline cortisol, corticotropin (ACTH), and dehydropiandrosterone sulfate (DHEAS). Subsequently a low-dose (1 μg) ACTH test was performed to determine stimulated cortisol. The incremental rise in cortisol was defined as stimulated minus baseline cortisol. Overall, 149 patients survived and 54 died. Nonsurvivors were older and in a more severe critical state, as reflected by higher SOFA and APACHE II scores. Nonsurvivors had a lower incremental rise in cortisol (5.0 vs. 8.3 μg/dl and lower DHEAS (1065 vs. 1642 ng/ml) than survivors. The two groups had similar baseline and stimulated cortisol. Multivariate logistic regression analysis revealed that age (odds ratio 1.02), SOFA score (1.36), and the incremental rise in cortisol (0.88) were independent predictors for poor outcome.

Conclusions

In general ICU patients a blunted cortisol response to ACTH within 24 h of admission is an independent predictor for poor outcome. In contrast, baseline cortisol or adrenal androgens are not of prognostic significance.

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Title: A prospective study on adrenal cortex responses and outcome prediction in acute critical illness: results from a large cohort of 203 mixed ICU patients
Authors: Ioanna Dimopoulou
Konstantinos Stamoulis
Ioannis Ilias
Marinella Tzanela
Panagiotis Lyberopoulos
Stylianos Orfanos
Apostolos Armaganidis
Maria Theodorakopoulou
Stylianos Tsagarakis
Publication date: 01-12-2007
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 12/2007
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-007-0790-0

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

A prospective study on adrenal cortex responses and outcome prediction in acute critical illness: results from a large cohort of 203 mixed ICU patients

Abstract

Objective

Design and setting

Patients

Measurements and results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objective

Design and setting

Patients

Measurements and results

Conclusions

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