Dikme Ozlem, Dikme Ozgur
Emergency Department, Koc University Hospital, Istanbul 34035, Turkey.
Emergency Department, University of Health Sciences Istanbul Training and Research Hospital, Istanbul 34035, Turkey.
Emerg Med Int. 2018 Oct 11;2018:1758643. doi: 10.1155/2018/1758643. eCollection 2018.
Cortisol is a steroid hormone released from the adrenal glands in response to stressful conditions. Elevated cortisol levels have been described in stress, but it is unclear whether these are associated with adverse outcomes. In this study, we assess whether cortisol levels drawn in patients presenting with dyspnea to the ED were a predictor of major adverse pulmonary event (MAPE). In 87 patients presenting with dyspnea to the ED, cortisol levels were determined. Patients were then assessed to determine the following MAPE: endotracheal intubation (ETI) in the ED, admission to the intensive care unit (ICU), and in-hospital all-cause mortality. Forty-four patients (50.6%) were female and 33 (37.9%) were diagnosed with heart failure. Cortisol levels in patients with and without MAPE were 34.3g/dL and 23.8g/dL, respectively (p<0.001). Also, cortisol levels were found higher in patients intubated in the ED than nonintubated patients (54.2g/dL vs 25.7g/dL, p<0.001), higher in patients admitted to the ICU (38.7g/dL vs 24 g/dL, p<0.001), and higher in patients who died in hospital (50g/dL vs 24.3g/dL, p<0.001). The area under the ROC curve using cortisol to detect any component of MAPE-ETI or ICU admission or in-hospital all-cause mortality-was 0.76 (95% CI, 0.65-0.84). A cortisol value of 31.4g/dL had sensitivity of 70.8% and specificity of 79.4% for predicting MAPE. Patients in the MAPE group had higher serum cortisol levels than those without any MAPE. Cortisol may be used as a marker to predict MAPE in nontraumatic acutely dyspneic adult patients on ED admission.
皮质醇是一种在应激状态下从肾上腺释放的类固醇激素。应激状态下皮质醇水平会升高，但目前尚不清楚这些升高的水平是否与不良后果相关。在本研究中，我们评估了因呼吸困难到急诊科就诊的患者所检测的皮质醇水平是否为主要不良肺部事件（MAPE）的预测指标。在87例因呼吸困难到急诊科就诊的患者中，测定了皮质醇水平。随后对患者进行评估以确定以下MAPE情况：在急诊科进行气管插管（ETI）、入住重症监护病房（ICU）以及院内全因死亡率。44例患者（50.6%）为女性，33例（37.9%）被诊断为心力衰竭。发生MAPE和未发生MAPE的患者皮质醇水平分别为34.3μg/dL和23.8μg/dL（p<0.001）。此外，在急诊科接受插管的患者皮质醇水平高于未插管患者（54.2μg/dL对25.7μg/dL，p<0.001），入住ICU的患者皮质醇水平更高（38.7μg/dL对24μg/dL，p<0.001），院内死亡患者的皮质醇水平也更高（50μg/dL对24.3μg/dL，p<0.001）。使用皮质醇检测MAPE（ETI或ICU入住或院内全因死亡率）任何组成部分的ROC曲线下面积为0.76（95%CI，0.65 - 0.84）。皮质醇值为31.4μg/dL预测MAPE的敏感性为70.8%，特异性为79.4%。MAPE组患者的血清皮质醇水平高于无任何MAPE的患者。皮质醇可作为预测急诊科收治的非创伤性急性呼吸困难成年患者发生MAPE的标志物。
