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Original Article
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- 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
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- 5 Web of Science
- 4 Crossref
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Abstract
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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
- Serum ACTH and Cortisol Level is Associated with the Acute Gastrointestinal Injury Grade in ICU Patients
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