Bjekić-Macut Jelica, Radosavljević Vojislav, Andrić Zoran, Ilić Dušan, Stanojlović Olivera, Milutinović Danijela Vojnović, Antić Ivana Božić, Zdravković Marija, Hinić Saša, Macut Djuro, Žarković Miloš
UMC Bežanijska kosa, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Clinic of Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
J Med Biochem. 2016 Nov 2;35(4):428-435. doi: 10.1515/jomb-2016-0015. eCollection 2016 Oct.
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 ACTH in patients with SIRS at admission to the Respiratory Intensive Care Unit (RICU) and seven days later.
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.
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.
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.
全身炎症反应综合征（SIRS）会改变皮质醇动态变化，并提示肾上腺皮质与下丘脑 - 垂体单位之间存在分离。本研究的目的是评估呼吸重症监护病房（RICU）收治的SIRS患者入院时及7天后促肾上腺皮质激素（ACTH）刺激后的皮质醇反应。
本研究纳入了54名受试者，SIRS根据1992年共识会议标准进行定义。使用急性生理与慢性健康状况评分系统II（APACHE II）评分确定疾病严重程度，使用序贯器官衰竭评估（SOFA）评分确定器官功能障碍。对所有患者进行低剂量（1μg）ACTH试验（LDT），并测定皮质醇及基础ACTH。使用参数检验、非参数检验和回归分析对数据进行分析。结果以均值±标准差表示，P<0.05被认为具有统计学意义。
两次LDT的皮质醇值无差异。在SIRS发作时，14/54（25.9%）的受试者在LDT期间皮质醇增加值低于250nmol/L。54名患者中有5名（9.6%）在SIRS发作后7天内死亡。女性性别和LDT时的最大皮质醇反应（▵max）可预测在RICU的住院时间，而APACHE II和SOFA评分最能预测住院时间、死亡率及总体生存结局。
在SIRS诊断时和7天后发现▵max存在差异。▵max，主要是临床评分APACHE II和SOFA可预测住院结局和总体生存情况。
