TY - JOUR
TI - Adrenal function in non-septic long-stay critically ill patients:
evaluation with the low-dose (1 mu g) corticotropin stimulation test
AU - Dimopoulou, L
AU - Ilias, L
AU - Roussou, P
AU - Gavala, A
AU - Malefaki, A
AU - and Milou, E
AU - Pitaridis, M
AU - Roussos, C
JO - Intensive Care Medicine Experimental
PY - 2002
VL - 28
TODO - 8
SP - 1168-1171
PB - Springer-Verlag
SN - 2197-425X
TODO - 10.1007/s00134-002-1360-0
TODO - protracted critical illness; adrenocortical function; low-dose ACTH
test; cortisol; interleukin-6; outcome
TODO - Objective: To investigate the adrenal function in non-septic, long-stay
critically ill patients. Design: Prospective, consecutive study.
Setting: General intensive care unit in a university hospital. Patients:
Forty-three non-septic patients with protracted critical illness.
Interventions: A morning blood sample was first obtained to measure
baseline plasma cortisol. Subsequently, 1 mug of corticotropin (ACTH,
Synacthene) was injected intravenously and 30 min later a second blood
sample was drawn to determine stimulated plasma cortisol. Patients
having a stimulated cortisol level of at least 18 pg/dl were defined as
responders. In 36 patients, morning interleukin-6 (IL-6) was also
measured. Measurements and results: Baseline and stimulated plasma
cortisol were 16.8 +/- 4.1 pg/dl and 21.2 +/- 5.1 pg/dl, respectively.
Interleukin-6 was high (median 39.3 pg/ml, interquartile range 24.9-86.6
pg/ml) and correlated negatively with stimulated plasma corti-sol
(r=-0.40, p<0.05). Of the 43 patients studied, 31 patients (72%) were
responders and 12 patients (28%) were non-responders to the ACTH
stimulation test. Overall, 18 patients died and 25 patients survived to
hospital discharge. Non-responders had significantly higher IL-6 levels
compared to responders (106 +/- 73 versus 48 42 pg/ml, p<0.05), whereas
mortality rate was comparable in the two groups (50% versus 38%,
p=0.74). Conclusions: Circulating plasma IL-6 levels are high during
protracted critical illness, and are partially responsible for the
relative adrenal insufficiency found in a subset of severely ill
patients.
ER -