@article{3181497,
    title = "Salivary biomarkers may measure stress responses in critically ill
children",
    author = "Tzira, Despoina and Prezerakou, Anargyroula and Papadatos, Ioannis and and Vintila, Artemis and Bartzeliotou, Anastasia and Apostolakou, Filia and and Papassotiriou, Ioannis and Papaevangelou, Vassiliki",
    journal = "Sage Open Medicine",
    year = "2018",
    volume = "6",
    publisher = "SAGE Publications Inc.",
    issn = "2050-3121",
    doi = "10.1177/2050312118802452",
    keywords = "Salivary cortisol; amylase; IgA; stress; pediatric critical illness",
    abstract = "Objective: Measurement of salivary biomarkers can provide important
information regarding hypothalamic-pituitary-adrenal axis activity both
under normal conditions as well as in response to psychological or
physical stress. Our aim was to correlate salivary stress markers, such
as cortisol, -amylase and immunoglobulin A, with the Pediatric Risk
Index Score of Mortality, underlying disease (pathologic, trauma and
postoperative), need for mechanical ventilation/sedation and time lag
between onset of illness and admission in children admitted in the
pediatric intensive care unit.
Methods: We enrolled 79 pediatric intensive care unit patients
(2-14years) over a 2-year period, which satisfy the including criteria,
but finally salivary biomarkers were evaluated in 65 patients. Saliva
samples were collected within 24h of admission at 8a.m., 2p.m. and 8p.m.
to examine potential disruption of circadian rhythm.
Results: Overall, the salivary biomarkers were increased; specifically,
median values were (a) cortisol at 8a.m.: 50.04nmol/L, 2p.m.:
30.69nmol/L and 8p.m.: 247.12nmol/L; (b) -amylase: at 8a.m.: 22.567U/L;
2p.m.: 22.702U/L and 8p.m.: 21.484U/L and (c) IgA at 8a.m.: 95.10mg/dL,
2p.m.: 88.55mg/dL and 8p.m.: 80.80mg/dL. Significantly higher levels
were demonstrated in children younger than 6years and those with
Pediatric Risk Index Score of Mortality 8 upon admission. Disturbances
in circadian rhythm were observed. Cortisol circadian rhythm disturbance
was observed only in children with Pediatric Risk Index Score of
Mortality score 8 upon admission while maintaining normal -amylase
circadian rhythm, which was associated with less than 3days
hospitalization in pediatric intensive care unit. No daily variance in
IgA was observed.
Conclusion: Salivary biomarkers may serve, in critically ill children,
as a sensitive, non-invasive method, important for the early recognition
of those at high risk and guiding intervention, before clinical
deterioration, promoting the quality of health care in pediatric
population."
}