Cortisol changes among patients with septic shock and the relationship to ICU and hospital stay
Cortisol changes among patients with septic shock and the relationship to ICU and hospital stay
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DOI：
10.1007/s00134-005-2770-6
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发表时间：
2005-10-01
影响因子：
38.9
通讯作者：
Weiss, YG
中科院分区：
文献类型：
--
作者：
Goodman, S;Sprung, CL;Weiss, YG
目的：探讨严重脓毒症及脓毒性休克患者肾上腺功能的变化。设计图：在ICU入院后第1天和第2天以及第28天或住院最后一天（本文中为第28天）的未刺激和高剂量ACTH刺激的皮质醇水平的前瞻性研究。地点：普通重症监护病房。患者：34例脓毒症患者。干预措施：在败血症的第1、2和28天，评价未刺激和ACTH刺激的皮质醇水平。终点为ICU和住院时间以及28天全因死亡率。测量和结果：第1天和第2天，8名患者的肾上腺功能不全标准定义为未刺激的皮质醇水平低于15 μ g/dl。第1天未受刺激皮质醇水平低于15 μ g/dl或变化为9 μ g/dl或更低的患者在ICU的停留时间更长。第1天未受刺激的皮质醇水平低于15 μ g/dl的患者也表现出较长的住院时间。在第1天的回归分析显示，未受刺激的皮质醇水平有显着的负相关与ICU的长度和住院时间。未刺激的皮质醇和ACTH后皮质醇之间的比例变化（Delta%）是一种新的模式; Delta%值越高，患者的ICU和住院时间越长。当比较未刺激的皮质醇与第28天的变化时，在幸存者中发现了显著的正相关。结论：本研究强调了脓毒症患者皮质醇水平的广泛变化。在第28天，我们观察到幸存者和非幸存者之间皮质醇反应模式的差异。未刺激的皮质醇和促肾上腺皮质激素后皮质醇之间的比例变化被用作评估患者之间皮质醇水平相对变化的方法。
Objective: To evaluate adrenal function in patients with severe sepsis or septic shock. Design: A prospective study of unstimulated and high-dose ACTH stimulated cortisol levels on days 1 and 2 following ICU admission and day 28 or last day of hospitalization (herein day 28). Setting: General intensive care unit. Patients: 34 septic patients. Interventions: On days 1, 2, and 28 of sepsis unstimulated and ACTH stimulated cortisol levels were evaluated. End-points were length of ICU and hospital stay and 28 day all cause mortality. Measurements and results: Eight patients on days 1 and 2 had criteria of adrenal insufficiency defined as unstimulated cortisol levels less than 15 mu g/dl. Patients with unstimulated cortisol levels less than 15 mu g/dl on day 1 or change of 9 mu g/dl or less had longer ICU stays. Patients with unstimulated cortisol levels less than 15 mu g/dl on day 1 also demonstrated longer hospital stay. On day 1 regression analysis revealed that unstimulated cortisol levels had a significant inverse correlation with length of ICU and hospital stay. The proportional change between unstimulated cortisol and post-ACTH cortisol (Delta%) is a new modality; the higher this Delta% value, the longer is the patient's ICU and hospital stay. A significant positive correlation was found in survivors when comparing unstimulated cortisol vs. day 28 changes. Conclusions: The present study highlights the wide range of cortisol levels among patients with sepsis. We observed a difference in cortisol response pattern between survivors and nonsurvivors on day 28. The proportional change between unstimulated cortisol and post-ACTH cortisol was used as a method to evaluate the relative change in cortisol levels between patients.