入院首日的皮质醇水平与外科重症患者的临床疗效有关。

Q4 Medicine Critical care explorations Pub Date : 2024-05-08 eCollection Date: 2024-05-01 DOI:10.1097/CCE.0000000000001086
Noam Goder, Fabian Gerstenhaber, Amir Gal Oz, Dekel Stavi, Yoel Angel, Asaph Nini, Yael Lichter, Oded Sold
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引用次数: 0

摘要

重要性目的:探讨入院首日皮质醇水平与临床结果之间的相关性:尽管大多数患者在应激时皮质醇水平会激增,但也有一些患者会出现与危重疾病相关的皮质类固醇不足(CIRCI)。关于这些患者中哪些人出现不良预后的风险更大,目前尚无定论:设计:回顾性研究:地点:一家三级医疗中心的外科重症监护病房(SICU):主要结果和测量指标:收集并分析了 1412 名符合条件的患者入院后 24 小时内的皮质醇水平(第 1 天 [D1] 皮质醇)。结果分为四组:皮质醇水平低(0-10 µg/dL)、正常(10-25 µg/dL)、高(25-50 µg/dL)和极高(50 µg/dL以上)。主要终点是 90 天死亡率。次要终点是器官支持需求(使用血管加压药和机械通气[MV])、重症监护室住院时间(LOS)和机械通气持续时间:大多数患者(63%)的 D1 皮质醇水平较高或很高,而 7.6% 的患者水平较低,因此可诊断为 CIRCI。四组患者的 90 天死亡率在统计学上有显著差异,高水平皮质醇是死亡率的一个独立风险因素,主要是在器官功能衰竭序列评估(SOFA)小于或等于 3 或 SOFA 大于或等于 7 的患者中。 较高的皮质醇水平与所有次要终点相关。CIRCI与良好的预后相关:在重症手术患者中,D1 皮质醇水平高于 50 毫微克/分升与死亡率、器官支持需求、ICU LOS 延长和 MV 持续时间有关,而低水平则与良好的临床预后相关,即使未经治疗也是如此。当 SOFA 小于或等于 3 或 SOFA 大于或等于 7 时,D1 皮质醇水平高于 50 毫微克/分升有助于区分非存活者和存活者。
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Cortisol Levels During First Admission Day Are Associated With Clinical Outcomes in Surgical Critically Ill Patients.

Importance: To explore the correlation between cortisol levels during first admission day and clinical outcomes.

Objectives: Although most patients exhibit a surge in cortisol levels in response to stress, some suffer from critical illness-related corticosteroid insufficiency (CIRCI). Literature remains inconclusive as to which of these patients are at greater risk of poor outcomes.

Design: A retrospective study.

Setting: A surgical ICU (SICU) in a tertiary medical center.

Participants: Critically ill patients admitted to the SICU who were not treated with steroids.

Main outcomes and measures: Levels of cortisol taken within 24 hours of admission (day 1 [D1] cortisol) in 1412 eligible patients were collected and analyzed. Results were categorized into four groups: low (0-10 µg/dL), normal (10-25 µg/dL), high (25-50 µg/dL), and very high (above 50 µg/dL) cortisol levels. Primary endpoint was 90-day mortality. Secondary endpoints were the need for organ support (use of vasopressors and mechanical ventilation [MV]), ICU length of stay (LOS), and duration of MV.

Results: The majority of patients (63%) had high or very high D1 cortisol levels, whereas 7.6% had low levels and thus could be diagnosed with CIRCI. There were statistically significant differences in 90-day mortality between the four groups and very high levels were found to be an independent risk factor for mortality, primarily in patients with Sequential Organ Failure Assessment (SOFA) less than or equal to 3 or SOFA greater than or equal to 7. Higher cortisol levels were associated with all secondary endpoints. CIRCI was associated with favorable outcomes.

Conclusions and relevance: In critically ill surgical patients D1 cortisol levels above 50 mcg/dL were associated with mortality, need for organ support, longer ICU LOS, and duration of MV, whereas low levels correlated with good clinical outcomes even though untreated. D1 cortisol level greater than 50 mcg/dL can help discriminate nonsurvivors from survivors when SOFA less than or equal to 3 or SOFA greater than or equal to 7.

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