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Adrenocortical function: An indicator of severity of disease and survival in chronic critically ill patients

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Abstract

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 μmol/l) was clearly elevated in these patients. The highest plasma cortisol levels were measured in patients treated with vasoactive drugs (0.76±0.39 μmol/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 μmol/l;p<0.0003 and 12.6±4.8 vs. 7.3±4.1;p<0.0001). A significant correlation was found between the individual weekly plasma cortisol levels and the Apache IIm-stay scores (r=0.41;p<0.0001), especially in the subgroup of patients, who never received glucocorticoids during their stay at the ICU (r=0.51;p<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.

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Authors and Affiliations

  1. Department of Medicine, Division of Endocrinology, Sint-Radboud University Hospital, Geert Grooteplein Zuid 8, NL-6500 HB, Nijmegen, The Netherlands

    L. F. R. Span, A. R. M. M. Hermus MD, A. J. Hoitsma, A. G. H. Smals & P. W. C. Kloppenborg

  2. Department of Critical Care Medicine, Sint-Radboud University Hospital, Nijmegen, The Netherlands

    A. K. M. Bartelink & J. S. F. Gimbrère

Authors
  1. L. F. R. Span
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  2. A. R. M. M. Hermus MD
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  3. A. K. M. Bartelink
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  4. A. J. Hoitsma
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  5. J. S. F. Gimbrère
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  6. A. G. H. Smals
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  7. P. W. C. Kloppenborg
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Span, L.F.R., Hermus, A.R.M.M., Bartelink, A.K.M. et al. Adrenocortical function: An indicator of severity of disease and survival in chronic critically ill patients. Intensive Care Med 18, 93–96 (1992). https://doi.org/10.1007/BF01705039

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  • DOI: https://doi.org/10.1007/BF01705039

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