Burkitt Jamie M, Haskins Steve C, Nelson Richard W, Kass Philip H
Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA.
J Vet Intern Med. 2007 Mar-Apr;21(2):226-31. doi: 10.1892/0891-6640(2007)21[226:raiidw]2.0.co;2.
A syndrome of relative adrenal insufficiency has been identified in septic humans, and is associated with hypotension and death. Relative adrenal insufficiency is generally associated with basal serum cortisol concentration within or above the reference range and a blunted cortisol response to adrenocorticotropic hormone administration. It is unknown whether relative adrenal insufficiency occurs in septic dogs.
That relative adrenal insufficiency occurs in septic dogs, and that relative adrenal insufficiency is associated with hypotension and mortality.
Thirty-three septic dogs admitted to a small animal intensive care unit.
Dogs were included in the study if they had a known or suspected infectious disease and had systemic inflammatory response syndrome. Dogs were excluded if they had disease or medication history expected to affect the hypothalamic-pituitary-adrenal axis. Serum cortisol and endogenous plasma adrenocorticotropic hormone concentrations were measured before, and serum cortisol concentration measured 1 hour after, intramuscular administration of 250 microg of cosyntropin/dog. The change in cortisol concentration (delta-cortisol) before and after cosyntropin administration was determined in each dog.
Hypotension was associated with lower delta-cortisol values (OR 1.3; CI 1.0-1.9; P = .029). delta-Cortisol cutoff of 3.0 microg/dL was most accurate for predicting hypotension, survival to discharge, and 28-day survival. The rate of death in dogs with delta-cortisol < or = 3 microg/dL was 4.1 times that of dogs with delta-cortisol > 3 microg/dL (RR 4.1; CI 1.5-12.3; P = .01).
Delta-cortisol < or = 3 microg/dL after adrenocorticotropic hormone administration is associated with systemic hypotension and decreased survival in septic dogs.
在感染性休克患者中已发现相对肾上腺皮质功能不全综合征，且与低血压和死亡相关。相对肾上腺皮质功能不全通常与基础血清皮质醇浓度在参考范围内或高于参考范围以及对促肾上腺皮质激素给药的皮质醇反应迟钝有关。目前尚不清楚感染性休克犬是否会发生相对肾上腺皮质功能不全。
感染性休克犬会发生相对肾上腺皮质功能不全，且相对肾上腺皮质功能不全与低血压和死亡率相关。
33只入住小动物重症监护病房的感染性休克犬。
如果犬患有已知或疑似传染病且有全身炎症反应综合征，则纳入研究。如果犬有预期会影响下丘脑 - 垂体 - 肾上腺轴的疾病或用药史，则排除。在肌肉注射每只犬250微克促肾上腺皮质激素之前和之后测量血清皮质醇和内源性血浆促肾上腺皮质激素浓度，并在注射后1小时测量血清皮质醇浓度。测定每只犬促肾上腺皮质激素给药前后皮质醇浓度的变化（皮质醇变化量）。
低血压与较低的皮质醇变化量值相关（比值比1.3；可信区间1.0 - 1.9；P = 0.029）。皮质醇变化量截断值为3.0微克/分升时，对预测低血压、出院存活和28天存活最为准确。皮质醇变化量≤3微克/分升的犬的死亡率是皮质醇变化量＞3微克/分升的犬的4.1倍（相对危险度4.1；可信区间1.5 - 12.3；P = 0.01）。
促肾上腺皮质激素给药后皮质醇变化量≤3微克/分升与感染性休克犬的全身性低血压和存活率降低相关。
