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2018, Number 1

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Med Crit 2018; 32 (1)

Association between serum cortisol level and mortality in post-surgical patients with hemorrhagic hypovolemic shock

Díaz GSP, Sánchez DJS, Martínez REA, García MRC, Peniche MKG, Calyeca SMV

Language: Spanish
References: 33
Page: 7-12
PDF size: 210.84 Kb.


ABSTRACT

Introduction: The use of corticosteroids for the treatment of patients with septic shock has led to consider their use in other pathological processes, including hypovolemic hemorrhagic shock, although with controversial results.
Material and methods: A prospective, longitudinal, observational and analytical cohort study was conducted. We included patients admitted to the intensive care unit (ICU) with a diagnosis of hypovolemic hemorrhagic shock secondary to a surgical event in the period from January 1 to July 31 of 2017.
Results: The cutoff point for serum cortisol at ICU admission was established using the ROC curve, estimated at 39.1 µg/dL, with an area under the curve of 1.00 (95%CI 0.0012-0.2487, p = 0.0001). Sensitivity was 100%, with a specificity of 100%. The positive and negative probability coefficients were 14 and zero, respectively.
Conclusion: Serum cortisol levels measured at admission to the ICU greater than 39.1 µg/dL are associated with higher mortality in post-surgical patients with hypovolemic hemorrhagic shock.


REFERENCES

  1. Munck A, Guyre PM, Holbrook NJ. Physiological functions of glucocorticoids in stress and their relation to pharmacological actions. Endocr Rev. 1984;5(1):25-44.

  2. Newton R. Molecular mechanisms of glucocorticoid action: what is important? Thorax. 2000;55(7):603-613.

  3. Tsigos C, Chrousos GP. Hypothalamic pituitary adrenal axis, neuroendocrine factors and stress. J Psychosomatic Res. 2002;53(4):865-871.

  4. Stein DM, Jessie EM, Crane S, Kufera JA, Timmons T, Rodriguez CJ, et al. Hyperacute adrenal insufficiency after hemorrhagic shock exists and is associated with poor outcomes. J Trauma Acute Care Surg. 2013;74(2):363-370.

  5. Mejía-Gómez LJ. Fisiopatología choque hemorrágico. Rev Mex Anest. 2014;37(1):S70-S76.

  6. Mutschler M, Nienaber U, Münzberg M, Fabian T, Paffrath T, Wölfl C, et al. Assessment of hypovolaemic shock at scene: is the PHTLS classification of hypovolaemic shock really valid? Emerg Med J. 2014;31(1):35-40.

  7. Zaloga G, Marik P. Hypothalamic-pituitary-adrenal insufficiency. Crit Care Clin. 2001;17(1):25-41.

  8. Bates AS, Van't Hoff W, Jones PJ, Clayton RN. The effect of hypopituitarism on life expectancy. J Clin Endocrinol Metab. 1996;81(3):1169-1172.

  9. Price SA, Spain DA, Wilson MA, Harris PD, Garrison RN. Altered vasoconstrictor and dilator responses after a “two-hit” model of sequential hemorrhage and bacteremia. J Surg Res. 1999;81(1):59-64.

  10. Arlt W, Allolio B. Adrenal insufficiency. The Lancet. 2003;361(9372):1881-1893.

  11. Maxime V, Lesur O, Annane D. Adrenal insufficiency in septic shock. Clin Chest Med. 2009;30(1):17-27.

  12. Schumer W. Steroids in the treatment of clinical septic shock. Ann Surg. 1976;184(3):333-341.

  13. Rushing GD, Britt RC, Britt LD. Effects of hemorrhagic shock on adrenal response in a rat model. Ann Surg. 2006;243(5):652-654.

  14. Melby JC. Drug spotlight program: systemic corticosteroid therapy. Pharmacology and endocrinologic considerations. Ann Intern Med. 1974;81(4):505-512.

  15. Reincke M, Allolio B, Wurth G, Winkelmann W. The hypothalamic-pituitary-adrenal axis in critical illness: response to dexamethasone and corticotropin-releasing hormone. J Clin Endocrinol Metab. 1993;77(1):151-156.

  16. Sibbald WJ, Short A, Cohen MP, Wilson RF. Variations in adrenocortical responsiveness during severe bacterial infections: unrecognized adrenocortical insufficiency in severe bacterial infections. Ann Surg. 1977;186(1):29-33.

  17. Smith SM, Vale WW. The role of the hypothalamic-pituitary-adrenal axis in neuroendocrine responses to stress. Dialogues Clin Neurosci. 2006;8(4):383-395.

  18. Hietbrink F, Koenderman L, Rijkers G, Leenen L. Trauma: the role of the innate immune system. World J Emerg Surg. 2006;1:15.

  19. Rodríguez ND, Rodríguez AM, Alfonso AL, Castellanos PE, Reyes MM, Quintana RM. Respuesta metabólica en el trauma. Rev Cub Med Mil. 2012;41(1):96-104.

  20. Guirao X, Lowry SF. Biologic control of injury and inflammation: much more than too little or too late. World J Surg. 1996;20(4):437-446.

  21. Schelling G, Stoll C, Kapfhammer HP, Rothenhäusler HB, Krauseneck T, Durst K, et al. The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder and health-related quality of life in survivors. Crit Care Med. 1999;27(12):2678-2683.

  22. Joseph B, Haider AA, Pandit V, Kulvatunyou N, Orouji T, Khreiss M, et al. Impact of hemorrhagic shock on pituitary function. J Am Coll Surg. 2015;221(2):502-508.

  23. Bernard F, Outtrim J, Menon DK, Matta BF. Incidence of adrenal insufficiency after severe traumatic brain injury varies according to definition used: clinical implications. Br J Anaesth. 2006;96(1):72-76.

  24. Weant KA, Sasaki-Adams D, Dziedzic K, Ewend M. Acute relative adrenal insufficiency after aneurysmal subarachnoid hemorrhage. Neurosurgery. 2008;63(4):645-649.

  25. De Waele JJ, Hoste EA, Baert D, Hendrickx K, Rijckaert D, Thibo P, et al. Relative adrenal insufficiency in patients with severe acute pancreatitis. Intensive Care Med. 2007;33(10):1754-1760.

  26. Huang CJ, Lin HC. Association between adrenal insufficiency and ventilator weaning. Am J Respir Crit Care Med. 2006;73(3):276-280.

  27. Casares VM, Raurich PJ, Ayestarán RI, Llompart SE, Ibáñez Juvé J. Shock séptico e insuficiencia suprarrenal relativa. Med Intensiva. 2003;27(8):525-530.

  28. Albert SG, Ariyan S, Rather A. The effect of etomidate on adrenal function in critical illness: a systematic review. Intensive Care Med. 2011;37(6):901-910.

  29. Pene F, Hyvernat H, Mallet V, Cariou A, Carli P, Spaulding Ch, et al. Prognostic value of relative adrenal insufficiency after out-of-hospital cardiac arrest. Intensive Care Med. 2005;31(5):627-633.

  30. Venkatesh B, Cohen J, Cooper M. Ten false beliefs about cortisol in critically ill patients. Intensive Care Med. 2015;41(10):1817-1819.

  31. Boonen E, Vervenne H, Meersseman P, Andrew R, Mortier L, Declercq PE, et al. Reduced cortisol metabolism during critical illness. N Engl J Med. 2013;368(16):1477-1488.

  32. Boonen E, Van den Berghe G. Cortisol metabolism in critical illness: implications for clinical care. Curr Opin Endocrinol Diabetes Obes. 2014;21(3):185-192.

  33. Rothermel LD, Lipman JM. Estimation of blood loss is inaccurate and unreliable. Surgery. 2016;160(4):946-953.




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