Adrenocortical function: An indicator of severity of disease and survival in chronic critically ill patients
| Autor: | Lambert F.R. Span, J. S. F. Gimbrère, A. G. H. Smals, Andries J. Hoitsma, A. K. M. Bartelink, Peter W. C. Kloppenborg, A. R. M. M. Hermus |
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| Rok vydání: | 1992 |
| Předmět: |
Adult
Male medicine.medical_specialty Resuscitation Adolescent Hydrocortisone Critical Illness Critical Care and Intensive Care Medicine Severity of Illness Index Hospitals University Risk Factors Internal medicine Intensive care Severity of illness medicine Humans Prospective Studies Prospective cohort study Survival rate Adrenocortical Insufficiency Aged Netherlands Aged 80 and over APACHE II business.industry Incidence Middle Aged Prognosis Survival Rate Intensive Care Units Endocrinology Chronic Disease business Adrenal Insufficiency medicine.drug |
| Zdroj: | Intensive Care Medicine. 18:93-96 |
| ISSN: | 1432-1238 0342-4642 |
| DOI: | 10.1007/bf01705039 |
| Popis: | Plasma cortisol levels and modified Apache II (Apache IIm-stay) severity of disease scores were determined at weekly intervals in 159 patients who were treated for at least 7 days at the Critical Care Unit of our hospital. The mean (+/- SD) plasma cortisol level (0.60 +/- 0.28 mumol/l) was clearly elevated in these patients. The highest plasma cortisol levels were measured in patients treated with vasoactive drugs (0.76 +/- 0.39 mumol/l). Non-survivors (n = 36) had a significantly higher mean plasma cortisol level and Apache IIm-stay score than survivors (respectively 0.78 +/- 0.40 vs. 0.54 +/- 0.21 mumol/l; p less than 0.0003 and 12.6 +/- 4.8 vs. 7.3 +/- 4.1; p less than 0.0001). A significant correlation was found between the individual weekly plasma cortisol levels and the Apache IIm-stay scores (r = 0.41; p less than 0.0001), especially in the subgroup of patients, who never received glucocorticoids during their stay at the ICU (r = 0.51; p less than 0.0001). During the 14-month study period only two patients showed a clinical picture of adrenocortical insufficiency and a blunted response of cortisol to 0.25 mg synthetic ACTH(1-24). In conclusion, our data suggest that a high plasma cortisol level, like a high Apache IIm-stay score, indicates severity of disease and poor survival in critically ill patients. De novo adrenocortical insufficiency is rare and therefore routine screening of adrenocortical function is superfluous. |
| Databáze: | OpenAIRE |
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