Critical illness-related corticosteroid insufficiency in cancer patients

Bruno, Jeffrey J.; Hernandez, Mike; Ghosh, S.; Pravinkumar, S. Egbert

doi:10.1007/s00520-011-1191-z

Cited by 9 publications

(3 citation statements)

References 31 publications

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“…Critical illness‐related corticosteroid insufficiency is believed to have an approximate overall prevalence of 30% in critically ill people and the prevalence increases to approximately 60% in people with septic shock . Despite several research studies supporting the existence of and treatment for CIRCI, there is also evidence of the contrary . It is considered a controversial concept in human medicine and not widely accepted …”

Section: Individual Organ System Dysfunctionmentioning

confidence: 99%

Multiple Organ Dysfunction Syndrome in Humans and Animals

Osterbur¹,

Mann

Kuroki

et al. 2014

Veterinary Internal Medicne

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Multiple organ dysfunction syndrome (MODS), defined as the presence of altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention, is a cause of high morbidity and mortality in humans and animals. Many advances have been made in understanding the pathophysiology and treatment of this syndrome in human medicine, but much still is unknown. This comparative review will provide information regarding the history and pathophysiology of MODS in humans and discuss how MODS affects each major organ system in animals.

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Section: Individual Organ System Dysfunctionmentioning

confidence: 99%

Multiple Organ Dysfunction Syndrome in Humans and Animals

Osterbur¹,

Mann

Kuroki

et al. 2014

Veterinary Internal Medicne

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“…More than half of our mechanically ventilated patients had CIRCI, and the presence of CIRCI was not associated with increased mortality. Other studies have also shown that the presence of CIRCI does not affect the outcome of critically ill patients [ 20 - 22 ]. Another interesting finding of this study was that that delta salivary cortisol, but not the delta serum cortisol, was significantly higher in survivors than in non-survivors.…”

Section: Discussionmentioning

confidence: 99%

Comparison of salivary and serum cortisol levels in mechanically ventilated patients and non-critically ill patients

Kim

Lee

et al. 2020

Acute Crit Care

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Comparison of salivary and serum cortisol levels in mechanically ventilated patients and non-critically ill patients Background: Although the measuring free cortisol is ideal for assessment of hypothalamicpituitary-adrenal function, it is not routinely measured. Salivary cortisol correlates well with the biologically active free cortisol. Therefore, this study measured the morning basal as well as adrenocorticotropic hormone-stimulated salivary cortisol levels in mechanically ventilated patients and compared the results with non-critically ill patients. Methods: We prospectively enrolled 49 mechanically ventilated patients and 120 patients from the outpatient clinic. Serum and saliva samples were collected between 8 AM and 10 AM. Salivary cortisol levels were measured using an enzyme immunoassay kit. The salivary samples were insufficient in 15 mechanically ventilated patients (30.6%), and these patients were excluded from the final analysis. Results: Mechanically ventilated patients (n = 34) were significantly older and had lower body mass index and serum albumin levels and higher serum creatinine levels than non-critically ill patients (n = 120). After adjustment for these parameters, both basal and stimulated salivary and serum cortisol levels were higher in mechanically ventilated patients. The increase in cortisol was not significantly different between the two groups. Serum cortisol levels showed a positive correlation with salivary cortisol levels. Among mechanically ventilated patients, both basal serum and salivary cortisol levels were lower in survivors than in non-survivors. Conclusions: Both basal total serum and salivary cortisol levels were elevated in mechanically ventilated patients and in non-survivors.

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“…This result is also in accordance with those of other studies dissociating CIRCI from an adverse outcome. (28,34) Perhaps refractory septic shock could be the only indication for corticosteroids treatment as usually done in most centers nowadaysand is recommended in the Surviving Sepsis Campaign (SSC) guidelines. (35,36) …”

Section: Discussionmentioning

confidence: 99%

Insuficiência adrenal relativa como preditora de gravidade de doença e mortalidade do choque séptico

Dalegrave¹,

Silva²,

Becker³

et al. 2012

Rev. bras. ter. intensiva

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ObjectiveTo evaluate if cortisol responses to 250 µg of intravenously administered adrenocorticotropic hormone are related to disease severity and, hence, mortality. MethodsThis is a retrospective study in a medical-surgical intensive care unit of a university hospital. We studied 69 consecutive patients with septic shock over a 1-yr period; these patients underwent a short 250-µg adrenocorticotropic hormone test because they exhibited >6 hours of progressive hemodynamic instability requiring repeated fluid challenges and vasopressor treatment to maintain blood pressure. The test was performed by intravenously injecting 250 µg of synthetic adrenocorticotropic hormone and measuring cortisol immediately before injection, 30 minutes post-injection and 60 minutes post-injection. ResultsThe mean APACHE II score was 22±7. The intensive care unit mortality rate at day 28 was 55%. Median baseline cortisol levels (19 [11-27] µg/dL versus 24 [18-34] µg/dL, p=0.047) and median baseline cortisol/albumin ratios (7.6 [4.6-12.3] versus 13.9 [8.8-18.5]; p=0.01) were lower in survivors than in non-survivors. Responders and non-responders had similar baseline clinical data and outcomes. The variables that were significantly correlated with outcome based on the area under the ROC curves (AUC) were APACHE II (AUC=0.67 [0.535 to 0.781]), baseline cortisol (µg/dl) (AUC=0.662 [0.536 to 0.773], peak cortisol (µg/dl) (AUC=0.642 [0.515 to 0.755]) and baseline cortisol/albumin (AUC=0.75 [0.621 to 0.849]). ConclusionsIncreased basal cortisol is associated with mortality and disease severity. Cortisol responses upon adrenocorticotropic hormone stimulation were not related to outcome. The cortisol/albumin ratio does not predict unfavorable outcomes better than total cortisol levels or help to improve the accuracy of the adrenocorticotropic hormone test.

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Critical illness-related corticosteroid insufficiency in cancer patients

Abstract: The incidence of CIRCI in cancer patients with severe sepsis or septic shock appears high. Further large-scale prospective trials are needed to confirm these findings.

Cited by 9 publications

References 31 publications

Multiple Organ Dysfunction Syndrome in Humans and Animals

Multiple Organ Dysfunction Syndrome in Humans and Animals

Comparison of salivary and serum cortisol levels in mechanically ventilated patients and non-critically ill patients

Insuficiência adrenal relativa como preditora de gravidade de doença e mortalidade do choque séptico

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