Pediatric department, Faculty of Medicine, Fayoum University, Fayoum, Egypt.
Pediatric department, Kasr AlAiny Faculty of Medicine, Cairo University, Cairo, Egypt.
Sci Rep. 2019 Apr 12;9(1):6008. doi: 10.1038/s41598-019-42443-z.
Elevated cortisol level is an component of the stress response. However, some patients have low cortisol levels; a condition termed: critical illness-related corticosteroid insufficiency (CIRCI). Basal cortisol levels during PICU admission may be related to outcome. This prospective cohort study aimed to assess basal total serum cortisol levels and their relation to outcome in PICU. The study included 81 children over 6 months. Total serum cortisol was assessed using an early morning sample. The severity of illness was assessed using the PRISM-III score. Outcome measures included mechanical ventilation duration, use of inotropic support, length of stay, mortality. Comparison between patients' subgroups according to total serum cortisol levels revealed significantly higher PRISM-III score in patients with total serum cortisol levels. In addition, those patients had a significantly higher mortality rate when compared with patients with low and normal total serum cortisol levels. Multivariate logistic regression analysis recognized high total serum cortisol level and PRISM-III score as significant predictors of mortality. We concluded that PRISM-III score and elevated total serum cortisol levels are significant predictors of mortality in the PICU. Although CIRCI is prevalent in this population, it wasn't associated with an increased mortality rate.
皮质醇水平升高是应激反应的一个组成部分。然而，有些患者皮质醇水平较低；这种情况被称为：危重病相关皮质激素不足（CIRCI）。PICU 入院时的基础皮质醇水平可能与预后有关。这项前瞻性队列研究旨在评估 PICU 中基础总血清皮质醇水平及其与预后的关系。该研究纳入了 81 名 6 个月以上的儿童。使用清晨样本评估总血清皮质醇。使用 PRISM-III 评分评估疾病严重程度。预后指标包括机械通气时间、使用正性肌力支持、住院时间、死亡率。根据总血清皮质醇水平对患者亚组进行比较，结果显示总血清皮质醇水平较高的患者 PRISM-III 评分显著较高。此外，与总血清皮质醇水平较低和正常的患者相比，这些患者的死亡率显著更高。多变量逻辑回归分析识别出高总血清皮质醇水平和 PRISM-III 评分是死亡率的显著预测因子。我们得出结论，PRISM-III 评分和升高的总血清皮质醇水平是 PICU 死亡率的显著预测因子。尽管该人群中普遍存在 CIRCI，但它与死亡率的增加无关。
