Relation between Baseline Total Serum Cortisol Level and Outcome in Pediatric Intensive Care Unit

Osama E Bekhit,Nirvana A Khalaf,Shereen A Mohamed,Fatma Salah,Hoiyda A Abdelrasol,Remon M Yousef

doi:10.1038/s41598-019-42443-z

Osama E Bekhit, Nirvana A Khalaf + Show 4 more

Open Access

https://doi.org/10.1038/s41598-019-42443-z

Copy DOI

Abstract

Elevated cortisol level is an component of the stress response. However, some patients have low cortisol levels; a condition termed: critical illness-related corticosteroid insufficiency (CIRCI). Basal cortisol levels during PICU admission may be related to outcome. This prospective cohort study aimed to assess basal total serum cortisol levels and their relation to outcome in PICU. The study included 81 children over 6 months. Total serum cortisol was assessed using an early morning sample. The severity of illness was assessed using the PRISM-III score. Outcome measures included mechanical ventilation duration, use of inotropic support, length of stay, mortality. Comparison between patients’ subgroups according to total serum cortisol levels revealed significantly higher PRISM-III score in patients with total serum cortisol levels. In addition, those patients had a significantly higher mortality rate when compared with patients with low and normal total serum cortisol levels. Multivariate logistic regression analysis recognized high total serum cortisol level and PRISM-III score as significant predictors of mortality. We concluded that PRISM-III score and elevated total serum cortisol levels are significant predictors of mortality in the PICU. Although CIRCI is prevalent in this population, it wasn’t associated with an increased mortality rate.

Highlights

Critical illness entails a complex pathological process that triggers exaggerated inflammatory and stress responses together with systemic dysregulation of endocrine functions
The present study included 81 children admitted to the PICU over a 6 months period
Comparison between patients’ subgroups classified according to basal total serum cortisol levels revealed significantly higher PRISM-III score in patients with cortisol levels ≥35 μg/dl. Those patients had significantly higher mortality rate when compared with patients with low and normal total serum cortisol levels (39.3% vs 6.7% and 18.4% respectively; p = 0.033)

Summary

Introduction

Critical illness entails a complex pathological process that triggers exaggerated inflammatory and stress responses together with systemic dysregulation of endocrine functions. These factors –if not properly managed- result in impaired tissue perfusion and multi-organ failure[1]. The relation between cortisol response and ICU outcome remains controversial[5] with some reports documenting the detrimental effects of very high cortisol levels and others blaming low cortisol levels for unfavorable outcome[6,7,8]. In pediatric populations, altered cortisol response constitutes a special challenge to the managing teams. This issue was rarely investigated in comparison to the frequently published studies on adult patients[9]

Objectives

Methods

Results

Conclusion