Correlation between Cosyntropin Stimulation Study and Disease Severity in Children with Fluid- and Catecholamine-Refractory Shock in the Pediatric and Cardiovascular Intensive Care Unit

Iyer, Pallavi; Harrington, Brittany; Fadrowski, Jeffrey J.; Sibinga, Erica; Amankwah, Ernest K.

doi:10.1159/000484561

Cited by 3 publications

(8 citation statements)

References 21 publications

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“…Aydın et al detected a positive correlation between PRISM III scores and basal cortisol levels in 40 patients who were followed from their first day of admission in the PICU (21). Iyer et al reported a positive correlation between peak cortisol levels and PRISM III scores in children with fluid-and catecholamine-refractory shock; our study is in accordance with these findings (22).…”

Section: Discussionsupporting

confidence: 91%

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Evaluation of the Hypothalamic-Pituitary-Adrenal Axis in a Paediatric Intensive Care Unit

et al. 2019

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Background. Relative adrenal insufficiency (RAI) is the inadequate production of cortisol due to dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis during a severe illness. We evaluated the HPA axis and RAI in a tertiary pediatric intensive care unit (PICU).Methods. A total of 100 PICU patients were included in this prospective cohort study. Basal serum levels of adrenocorticotropic hormone (ACTH), cortisol values were compared with those in the control group. A low-dose ACTH stimulation test was performed in patients with basal cortisol levels below 18 µg/dL.Results. The basal cortisol levels of the PICU patients were significantly higher than those of the control group (P < 0.05). All tested patients (n= 24) had delta cortisol levels > 9 µg/dL and a peak cortisol response > 18 µg/dL. Basal cortisol levels were positively correlated with Pediatric Risk of Mortality (PRISM) III scores (P < 0.05; r = 0.363). The basal or stimulated cortisol levels of the patients who received glucocorticoid treatment were higher than the cut-off levels.Conclusions. High basal or stimulated cortisol levels are indicative of disease severity in the acute phase of stress. Patients with very high cortisol levels should be particularly carefully monitored because of the high mortality risk.

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Section: Discussionsupporting

confidence: 91%

“…Glucocorticoid treatment tends to be administered according to the clinical conditions of patients in the ICU, and not based on the ACTH stimulation test or basal cortisol levels (22). As observed in our study, the basal and stimulated cortisol levels of all patients were reasonable.…”

Section: Discussionsupporting

confidence: 73%

Evaluation of the Hypothalamic-Pituitary-Adrenal Axis in a Paediatric Intensive Care Unit

et al. 2019

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“…Furthermore, socioeconomic factors affected discharge decisions, with considerations such as transportation and caregiver availability playing significant roles. [8][9][10][11][12][13][14][15] Most of the studies confirm our findings.…”

Section: Discussionsupporting

confidence: 86%

Serum Cortisol Levels in Children with Catecholamine-Dependent Shock – A Prospective Observational Study

et al. 2024

Int. J. Res. Pharm. Sci.

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Pediatric septic shock poses a significant challenge in ICUs worldwide, with high mortality and morbidity rates despite medical advancements. Early recognition and aggressive management are crucial. Resistance to standard therapies in some cases suggests potential adrenal insufficiency, particularly relative adrenal insufficiency (RAI), though research is limited. This study aimed to assess adrenal insufficiency prevalence in pediatric septic shock by evaluating basal serum cortisol levels in 49 children aged 1 month to 12 years admitted to the PICU. Results showed a significant 41% prevalence of adrenal insufficiency, correlating with prolonged critical care needs. Despite increased interventions, mortality rates didn't notably differ between groups. Recognition of adrenal insufficiency is vital due to its association with extended critical care requirements. Further research, including stimulation tests and trials, is needed to distinguish absolute and relative adrenal insufficiency and assess potential benefits of steroid supplementation. This study underscores the importance of comprehensive management strategies incorporating adrenal function assessment in improving outcomes for critically ill children with septic shock.

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“…A total of 21 observational studies published before 2022 were analyzed, with a total of 2,212 enrolled subjects, of whom 57.97% were male and 42.03% were female. 5,6,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] The sample consisted of 1,810 subjects with critical illness, including 916 subjects with sepsis and septic shock, and 402 control subjects. The characteristics and outcomes of included studies are shown in Tables 1 and 2, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Nineteen of 21 studies stated that there was a relationship between elevated cortisol levels and mortality in critical illness patients, including those with sepsis, as shown in Table 3. 5,6,[13][14][15][16][17][19][20][21][22][24][25][26][27][28][29][30] One study agreed with the statement, but found no relationship between postserum ACTH stimulation test and mortality in critical illness patients. 17 Fourteen studies had mortality percentage data critical illness patients with elevated cortisol levels.…”

Section: Resultsmentioning

confidence: 99%

Cortisol levels associated with mortality in children with critical illness: a systematic review

Tolibin,

Widiretnani,

Moelyo

2023

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Background Critically ill patients, including those with sepsis, have increased cortisol levels due to activation of the hypothalamic-pituitary-adrenal (HPA) axis or critical illness-related corticosteroid insufficiency (CIRCI). Objective To evaluate for a possible association between cortisol levels and mortality from sepsis in pediatric patients by systematic review of the literature. Methods A systematic review was conducted on studies involving critically ill children, including those with sepsis. We included studies published between 2011-2020 analyzing data on cortisol levels (total serum cortisol, serum-free cortisol, salivary cortisol, real-time free cortisol, basal serum cortisol and post-adrenocorticotropin hormone (ACTH) stimulation test, or basal salivary cortisol and post-ACTH stimulation test), the predictive score for mortality (Pediatric Logistic Organ Dysfunction/PELOD), Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality (PIM), Vasotropic Inotropic Score (VIS), or Pediatric Critical Illness Score (PCIS)], mortality (non-survivor percentage), and CIRCI percentage as an outcome in patients with critical illness, sepsis, and septic shock. Results Twenty-one observational studies were included in our systematic review, with a total of 2,212 subjects, 916 of whom had sepsis. Nineteen studies indicated a positive association between elevated cortisol levels and mortality in critically ill children, but 2 studies stated that there was no association with the CIRCI percentage of 32.3 and 84.3% respectively. The mortality percentage of critically ill patients with elevated cortisol levels and sepsis were 25.81 (2.7-60)% and 35.31 (6-60)%, respectively. The percentages of CIRCI in critically ill and sepsis patients were 21.91 (0-84.3)% and 21.35 (0-84.3)%, respectively. Conclusion Cortisol levels may increase or decrease in critically ill children. Elevated cortisol levels are associated with mortality in septic children. The effect of CIRCI on mortality in critically ill children cannot be concluded.

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Correlation between Cosyntropin Stimulation Study and Disease Severity in Children with Fluid- and Catecholamine-Refractory Shock in the Pediatric and Cardiovascular Intensive Care Unit

Cited by 3 publications

References 21 publications

Evaluation of the Hypothalamic-Pituitary-Adrenal Axis in a Paediatric Intensive Care Unit

Evaluation of the Hypothalamic-Pituitary-Adrenal Axis in a Paediatric Intensive Care Unit

Serum Cortisol Levels in Children with Catecholamine-Dependent Shock – A Prospective Observational Study

Cortisol levels associated with mortality in children with critical illness: a systematic review

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