Background: Systemic 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.
Methods: Fifty-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.
Results: There 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.
Conclusions: A 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.
Uvod: Sindrom sistemskog inflamatornog odgovora (SIRS) menja dinamiku kortizola, ukazujući na disocijaciju između adrenalnog korteksa i hipotalamo-hipofizne jedinice. Cilj ovog rada je da se proceni odgovor kortizola na stimulaciju sa ACTH1-24 u bolesnika sa SIRS-om na prijemu u respiratornu jedinicu intenzivne nege (RICU) i sedam dana kasnije.
Metode: Pedeset četiri osobe su uključene u studiju, a SIRS je definisan prema kriterijumima Konsenzus konferencije iz 1992. Ozbiljnost bolesti je ustanovljena pomoću skora APACHE II, a organska disfunkcija pomoću skora SOFA. Niskodozni (1 μg) ACTH test (LDT) izveden je u svih bolesnika uz određivanje kortizola kao i bazalnog ACTH. Podaci su analizirani pomoću parametarskih i neparametarskih testova i regresione analize. Rezultati su predstavljeni kao srednje vrednosti ± standardna devijacija, a P<0,05 je smatrano statistički značajnim.
Rezultati: U ovom istraživanju nisu uočene razlike u nivou kortizola između dva LDT-a. Porast kortizola manji od 250 nmol/L tokom LDT-a nađen je kod 14/54 (25,9%) bolesnika prilikom postavljanja dijagnoze SIRS-a. Pet od 54 (9,6%) bolesnika je umrlo unutar sedam dana od početka SIRS-Δ. Ženski pol i maksimalni odgovor kortizola (A max) tokom LDT-a predviđaju trajanje hospitalizacije u RICU, dok skorovi APACHE II i SOFA najbolje predvilaju dužinu hospitalizacije, smrtni ishod kao i opšte preživljavanje.
Zaključak: Razlika u Δ max prilikom postavljanja dijagnoze SIRS-a i sedam dana kasnije a pre svega klinickiskorovi APACHE II i SOFA predvilaju ishod hospitalizacije i opšte preživljavanje.
Keywords: ACTH test; APACHE II; SOFA; cortisol; systemic inflammatory response syndrome.