Kwok Amy M, Davis James W, Dirks Rachel C, Sue Lawrence P, Wolfe Mary M, Kaups Krista
Department of Surgery, University of San Francisco-Fresno, Fresno, California, USA.
Trauma Surg Acute Care Open. 2020 Jan 19;5(1):e000386. doi: 10.1136/tsaco-2019-000386. eCollection 2020.
A low cortisol level has been shown to occur soon after trauma, and is associated with increased mortality. The purpose of this study was to investigate the impact of low cortisol levels in acute critically ill trauma patients. We hypothesized that patients would require increase vasopressor use, have a greater blood product administration, and increased mortality rate.
A blinded, prospective observational study was performed at an American College of Surgeons verified Level I trauma center. Adult patients who met trauma activation criteria, received initial treatment at Community Regional Medical Center and were admitted to the intensive care unit were included. Total serum cortisol levels were measured from the initial blood draw in the emergency department. Patients were categorized according to cortisol ≤15 µg/dL (severe low cortisol, SLC), 15.01-25 µg/dL (relative low cortisol, RLC), or >25 µg/dL (normal cortisol, NC) and compared on demographics, injury severity score, initial vital signs, blood product usage, vasopressor requirements, and mortality.
Cortisol levels were ordered for 280 patients; 91 were excluded and 189 were included. Penetrating trauma accounted for 19% of injuries and blunt trauma for 81%. 22 patients (12%) had SLC, 83 (44%) had RLC, and 84 (44%) had NC. This study found patients with admission SLC had higher rates of vasopressor requirements, required more units of blood, and had a higher mortality rate than both the RLC and NC groups.
Low cortisol level can be identified acutely after severe trauma. Trauma patients with SLC had larger blood product requirements, vasopressor use, and increase mortality. Initial cortisol levels are useful in identifying these high-risk patients.
Prognostic/epidemiologic study, level III.
创伤后不久即出现皮质醇水平降低，且与死亡率增加相关。本研究旨在探讨急性重症创伤患者皮质醇水平降低的影响。我们假设患者需要增加血管升压药的使用、更多的血液制品输注，且死亡率增加。
在美国外科医师学会认证的一级创伤中心进行了一项双盲前瞻性观察研究。纳入符合创伤激活标准、在社区区域医疗中心接受初始治疗并入住重症监护病房的成年患者。从急诊科首次采血时测量总血清皮质醇水平。根据皮质醇≤15μg/dL（严重低皮质醇，SLC）、15.01 - 25μg/dL（相对低皮质醇，RLC）或>25μg/dL（正常皮质醇，NC）对患者进行分类，并比较人口统计学、损伤严重程度评分、初始生命体征、血液制品使用情况、血管升压药需求和死亡率。
对280例患者进行了皮质醇水平检测；91例被排除，189例被纳入。穿透伤占损伤的19%，钝性伤占81%。22例患者（12%）为SLC，83例（44%）为RLC，84例（44%）为NC。本研究发现，入院时为SLC的患者血管升压药需求率更高，需要更多单位的血液，且死亡率高于RLC和NC组。
严重创伤后可急性识别低皮质醇水平。SLC的创伤患者血液制品需求量更大、使用血管升压药，且死亡率增加。初始皮质醇水平有助于识别这些高危患者。
预后/流行病学研究，三级。
