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

To assess whether adrenal cortex hormones predict ICU mortality in acute, mixed, critically ill patients. Prospective study in consecutive intensive care patients in the general ICU of a teaching hospital. 203 severely ill patients with multiple trauma (n = 93), medical (n = 57), or surgical (n = 53...

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Bibliographic Details
Published in:Intensive care medicine 2007-12, Vol.33 (12), p.2116-2121
Main Authors: DIMOPOULOU, Ioanna, STAMOULIS, Konstantinos, ILIAS, Ioannis, TZANELA, Marinella, LYBEROPOULOS, Panagiotis, ORFANOS, Stylianos, ARMAGANIDIS, Apostolos, THEODORAKOPOULOU, Maria, TSAGARAKIS, Stylianos
Format: Article
Language:English
Subjects:
Acute Disease - mortality
Adolescent
Adrenal cortex
Adrenal Cortex - secretion
Adrenocorticotropic Hormone - blood
Adult
Aged
Aged, 80 and over
Androgens
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Biomarkers - blood
Cohort Studies
Critical Illness - mortality
Critically ill
Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care
Endocrinology
Female
Greece - epidemiology
Head injuries
Health aspects
Hormones
Hospitals
Hospitals, Teaching
Humans
Hydrocortisone - blood
Illnesses
Intensive care
Intensive care medicine
Intensive Care Units
Logistic Models
Male
Medical sciences
Middle Aged
Mortality
Predictive Value of Tests
Prognosis
Prospective Studies
Regression analysis
Sepsis
Survival Analysis
Thoracic surgery
Trauma
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Summary:To assess whether adrenal cortex hormones predict ICU mortality in acute, mixed, critically ill patients. Prospective study in consecutive intensive care patients in the general ICU of a teaching hospital. 203 severely ill patients with multiple trauma (n = 93), medical (n = 57), or surgical (n = 53) critical states. 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 microg) 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 microg/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. 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.
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-007-0790-0