Cortisol Response to Low-dose (1 µg) ACTH Stimulation for the Prediction of Outcome in Patients with Systemic Inflammatory Response Syndrome.

Jelica Bjekić-Macut,Dušan Ilić,Ivana Božić Antić,Olivera Stanojlović,Danijela Vojnović Milutinović,Marija Zdravković,Vojislav Radosavljević,Djuro Macut,Miloš Žarković,Zoran Andrić,Saša Hinić

doi:10.1515/jomb-2016-0015

Abstract

SummaryBackgroundSystemic inflammatory response syndrome (SIRS) changes cortisol dynamics and indicates dissociation between the adrenal cortex and the hypothalamo-pituitary unit. The aim of this study was to assess the cortisol response after stimulation with ACTH1-24 in patients with SIRS at admission to the Respiratory Intensive Care Unit (RICU) and seven days later.MethodsFifty-four subjects were included in the study, and SIRS was defined according to the Consensus Conference criteria from 1992. Severity of the disease was determined using the APACHE II score, and organ dysfunction using the SOFA score. Low-dose (1, μg) ACTH test (LDT) was performed in all patients, and cortisol was determined along with basal ACTH. Data were analyzed using parametric and nonparametric tests and regression analysis. The results are presented as mean± standard deviation, and P<0.05 was considered statistically significant.ResultsThere were no differences in cortisol values between the two LDTs. Cortisol increment lower than 250 nmol/L during the LDT was found in 14/54 (25.9%) subjects at the onset of SIRS. Five out of 54 (9.6%)patients died within 7 days from the onset of SIRS. Female sex and maximal cortisol response (▵ max) on LDT predicted the duration of hospitalization in RICU, while APACHE II and SOFA scores best predicted the duration of hospitalization, mortality outcome as well as overall survival outcome.ConclusionsA difference was found in A max at the diagnosis of SIRS and seven days later. ▵ max, and primarily the clinical scores APACHE II and SOFA predicted the outcomes of hospitalization and overall survival.

Highlights

Systemic inflammatory response syndrome (SIRS) represents an inflammatory condition that spreads all over the body
The same societies accepted that severity of the disease is best predicted using the Acute Physiology and Chronic Health Evaluation II (APACHE II) score [2] while the patient’s outcome, namely organ dysfunction/failure during Intensive Care Unit (ICU) monitoring, is predicted using the Sequential Organ Failure Assessment (SOFA) score [3]
We investigated the possibility of predicting whether a patient will receive mechanical ventilation during his/her stay in the Respiratory Intensive Care Unit (RICU) and for how many days, based on patient characteristics collected at the onset of SIRS presented with APACHE II and SOFA scores

Summary

Introduction

Systemic inflammatory response syndrome (SIRS) represents an inflammatory condition that spreads all over the body. In comparison to the general term infection, sepsis is a condition in which the patient fulfills the criteria for SIRS, and has a known or very certain infection. SIRS is a serious condition that is related to systemic inflammation, organ dysfunction and complete cessation of functions. The American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) defined SIRS using the following criteria: body temperature below 36 °C or over 38 °C, heart rate over 90 per minute, tachypnea over 20 respirations per minute or carbon dioxide partial pressure below 4.3 kPa (32 mmHg), and leukocyte number lower than 4000 cells/mm (4 × 109 cells/L) or over 12.000 cells/mm (12 × 109 cells/L), or presence of over 10% of immature neutrophils [1]. The same societies accepted that severity of the disease is best predicted using the Acute Physiology and Chronic Health Evaluation II (APACHE II) score [2] while the patient’s outcome, namely organ dysfunction/failure during Intensive Care Unit (ICU) monitoring, is predicted using the Sequential Organ Failure Assessment (SOFA) score [3]

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