Acute and Critical Care

Original Articles

Basic science and research
Comparison of salivary and serum cortisol levels in mechanically ventilated patients and non-critically ill patients: Jung Hee Kim, Yoon Ji Kim, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2020;35(3):149-155. Published online August 31, 2020; DOI: https://doi.org/10.4266/acc.2020.00297

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Background
Although the measuring free cortisol is ideal for assessment of hypothalamicpituitary-adrenal function, it is not routinely measured. Salivary cortisol correlates well with the biologically active free cortisol. Therefore, this study measured the morning basal as well as adrenocorticotropic hormone-stimulated salivary cortisol levels in mechanically ventilated patients and compared the results with non-critically ill patients.
Methods
We prospectively enrolled 49 mechanically ventilated patients and 120 patients from the outpatient clinic. Serum and saliva samples were collected between 8 AM and 10 AM. Salivary cortisol levels were measured using an enzyme immunoassay kit. The salivary samples were insufficient in 15 mechanically ventilated patients (30.6%), and these patients were excluded from the final analysis.
Results
Mechanically ventilated patients (n=34) were significantly older and had lower body mass index and serum albumin levels and higher serum creatinine levels than non-critically ill patients (n=120). After adjustment for these parameters, both basal and stimulated salivary and serum cortisol levels were higher in mechanically ventilated patients. The increase in cortisol was not significantly different between the two groups. Serum cortisol levels showed a positive correlation with salivary cortisol levels. Among mechanically ventilated patients, both basal serum and salivary cortisol levels were lower in survivors than in non-survivors.
Conclusions
Both basal total serum and salivary cortisol levels were elevated in mechanically ventilated patients and in non-survivors.

Citations

Citations to this article as recorded by

Identity change and the transition to university: Implications for cortisol awakening response, psychological well‐being and academic performance
Siobhán M. Griffin, Alžběta Lebedová, Tegan Cruwys, Grace McMahon, Aoife Marie Foran, Magdalena Skrodzka, Stephen Gallagher, Annie T. Ginty, Orla T. Muldoon
Applied Psychology: Health and Well-Being.2025;[Epub] CrossRef
Evaluating perioperative stresses in children by noninvasive modalities using salivary cortisol and autonomic reactivity
Ayaka Adachi, Kentaro Fujiwara, Hiroko Watayo, Ailing Hu, Takuji Yamaguchi, Hisae Iida, Asuka Ishiyama, Masahiro Shimizu, Shuko Nojiri, Hiroyuki Koga, Hiroyuki Kobayashi, Geoffrey J. Lane, Atsuyuki Yamataka, Kazuto Suda
Pediatric Surgery International.2024;[Epub] CrossRef
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Journal of Occupational Health.2022;[Epub] CrossRef

Basic science and research
Prognostic Implication of Adrenocortical Response during the Course of Critical Illness: Jin Hwa Song, Jung Hee Kim, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2019;34(1):38-45. Published online January 30, 2019; DOI: https://doi.org/10.4266/acc.2018.00339

8,162 View
136 Download
5 Web of Science
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Abstract PDF Supplementary Material

Background
Critical illness-related corticosteroid insufficiency (CIRCI) and adrenocorticotropic hormone (ACTH)-cortisol dissociation are hormonal conditions frequently observed in patients in the intensive care unit (ICU). The aim of this study was to evaluate the association between ACTH-cortisol dissociation and clinical outcomes of critically ill patients. Methods: We retrospectively reviewed the medical records of 94 ICU patients who underwent two rapid cosyntropin tests during hospital admission and compared the clinical aspects of patients with and without ACTH-cortisol dissociation. ACTH-cortisol dissociation was defined as plasma ACTH and serum cortisol concentrations of <22 pmol/L and >600 nmol/L, respectively. Results: Dissociation was present in 30 of the 94 patients (31.9%). Patients with ACTH-cortisol dissociation in the initial test had significantly higher hospital mortality rate than those in the control group (55% vs. 25.7%, P=0.013) There was no difference in hospital mortality between patients classified as having CIRCI and those who were not. In multivariate adjusted Cox regression analysis, the mortality risk was higher in the group with ACTH-cortisol dissociation (hazard ratio, 2.98; 95% confidence interval, 1.34 to 6.63; P=0.007). Patients with dissociation in two consecutive stimulation tests showed the highest hospital mortality rate among groups classified according to stimulation test results (100% vs. 31.3%). Conclusions: The hospital mortality was higher in ICU patients diagnosed with ACTH-cortisol dissociation. It is clinically feasible to evaluate the presence of ACTH-cortisol dissociation by analyzing rapid ACTH stimulation test results in critically ill patients.

Citations

Citations to this article as recorded by

Serum ACTH and Cortisol Level is Associated with the Acute Gastrointestinal Injury Grade in ICU Patients
Wen Xu, Yuzhen Qiu, Hongping Qiu, Ming Zhong, Lei Li
International Journal of General Medicine.2024; Volume 17: 127. CrossRef
PROGNOSTIC VALUE OF LOW-DOSE ADRENOCORTICOTROPIC HORMONE TEST IN CRITICALLY ILL PATIENTS
Ahmad B. Abdelrehim, Fatma M. Mohsen, Mostafa A. Haredi, Zeinab Abdel Hameed, Walaa H. Ibrahim
Shock.2023; 59(6): 871. CrossRef
Copeptin and stress-induced hyperglycemia in critically ill patients: A prospective study
Lilian Rodrigues Henrique, Daisy Crispim, Tarsila Vieceli, Ariell Freires Schaeffer, Priscila Bellaver, Cristiane Bauermann Leitão, Tatiana Helena Rech, Antonio Palazón-Bru
PLOS ONE.2021; 16(4): e0250035. CrossRef
Comparison of salivary and serum cortisol levels in mechanically ventilated patients and non-critically ill patients
Jung Hee Kim, Yoon Ji Kim, Sang-Min Lee, Jinwoo Lee
Acute and Critical Care.2020; 35(3): 149. CrossRef

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