Cortisol is an associated-risk factor of brain dysfunction in patients with severe sepsis and septic shock.
Cortisol is an associated-risk factor of brain dysfunction in patients with severe sepsis and septic shock.
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DOI：
10.1155/2014/712742
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发表时间：
2014
影响因子：
--
通讯作者：
Vincent JL
中科院分区：
文献类型：
--
作者：
Nguyen DN;Huyghens L;Zhang H;Schiettecatte J;Smitz J;Vincent JL
目标。目的探讨严重脓毒症和感染性休克患者脑功能障碍的皮质醇水平。方法：研究方法。采用Richmond激越镇静评分(RASS)、停药后ICU混淆方法评分(CAM-ICU)和血清S100B脑损伤标志物测定，对128例脓毒症和镇静后昏迷患者的脑功能障碍进行了研究。分别于ICU入院后12小时内及以后4天每天测定血清皮质醇和S100B水平。结果。停药前脑功能障碍发生率为50%(/128)，停药后脑功能障碍发生率为84%(107/128)，以57岁以上患者多见(P=0.009)。脑功能障碍组皮质醇水平(P=0.007)和S100B水平(P=0.028)均高于无脑功能障碍组。皮质醇水平与ICU死亡率相关(危险比=1.17，P=0.024)。多因素Logistic回归分析显示，皮质醇[优势比(OR)：2.34，95%CI(2.01，3.22)，P=0.02]和皮质醇与年龄的联合作用(OR：1.004，95%CI(1.002，1.93)，P=0.038)与脑功能障碍有关，而与S100B无关。结论。皮质醇是严重脓毒症和感染性休克患者脑功能障碍的相关危险因素。
Objectives. To investigate cortisol levels in brain dysfunction in patients with severe sepsis and septic shock. Methods. In 128 septic and sedated patients, we studied brain dysfunction including delirium and coma by the evaluation of Richmond Agitation Sedation Scale (RASS), the Confusion Method Assessment in the ICU (CAM-ICU) after sedation withdrawal and the measurement of serum S100B biomarker of brain injury. Serum cortisol and S100B were measured within 12 hours after ICU admission and daily over the next four days. Results. Brain dysfunction was observed in 50% (64/128) before but in 84% (107/128) of patients after sedation withdrawal, and was more common in the patients older than 57 years (P = 0.009). Both cortisol (P = 0.007) and S100B levels (P = 0.028) were higher in patients with than patients without brain dysfunction. Cortisol levels were associated with ICU mortality (hazard ratio = 1.17, P = 0.024). Multivariate logistic regression showed that cortisol (odds ratio (OR): 2.34, 95% CI (2.01, 3.22), P = 0.02) and the combination effect of cortisol with age (OR: 1.004, 95% CI (1.002, 1.93), P = 0.038) but not S100B were associated with brain dysfunction. Conclusions. Cortisol was an associated-risk factor of brain dysfunction in patients with severe sepsis and septic shock.
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DOI：
10.1056/nejmoa1214969
发表时间：
2013-04-18
期刊：
The New England journal of medicine
影响因子：
--
作者：
Boonen E;Vervenne H;Meersseman P;Andrew R;Mortier L;Declercq PE;Vanwijngaerden YM;Spriet I;Wouters PJ;Vander Perre S;Langouche L;Vanhorebeek I;Walker BR;Van den Berghe G
通讯作者：
Van den Berghe G
DOI：
10.1186/cc6891
发表时间：
2008
期刊：
Critical care (London, England)
影响因子：
--
作者：
Pfister D;Siegemund M;Dell-Kuster S;Smielewski P;Rüegg S;Strebel SP;Marsch SC;Pargger H;Steiner LA
通讯作者：
Steiner LA
影响因子：
11.1
作者：
Marklund, N;Peltonen, M;Olsson, T
通讯作者：
Olsson, T
DOI：
10.1034/j.1600-0579.2003.00201.x
发表时间：
2003-05-01
影响因子：
6.3
作者：
McNicoll, L;Pisani, MA;Inouye, SK
通讯作者：
Inouye, SK
影响因子：
1.8
作者：
Pearson A;de Vries A;Middleton SD;Gillies F;White TO;Armstrong IR;Andrew R;Seckl JR;MacLullich AM
通讯作者：
MacLullich AM