Akahoshi Shogo, Mitani-Konno Marie, Murakami Taku, Hayashi Hiroshi, Morikawa Yoshihiko, Hagiwara Yusuke, Saito Osamu, Hataya Hiroshi, Hasegawa Yukihiro
Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Clin Pediatr Endocrinol. 2025 Jan;34(1):36-44. doi: 10.1297/cpe.2024-0048. Epub 2024 Nov 11.
Measuring cortisol is crucial for assessing adrenal function in patients under stress; however, its value can fluctuate owing to various clinical factors. This study aimed to identify predictors of cortisol levels in pediatric patients with acute physiological stress. Children who were urgently admitted to the general ward or pediatric intensive care unit for acute illness or postoperative care were enrolled, while those with suspected adrenal function abnormalities or on current steroid therapy were excluded. Cortisol was measured in serum samples collected within 72 h of registration and its association with clinical factors was explored. A total of 397 samples from 217 patients were analyzed between August and November 2021 showing a median cortisol level of 375 nmol/L (interquartile range: 190-646 nmol/L). Multiple regression analysis with a mixed-effects model identified the following predictors of higher cortisol levels: heart rate z-score (+43.8 nmol/L/point), body temperature (+42.3 nmol/L/°C), Pediatric Early Warning System score (+44.3 nmol/L/point), age 3-6 yr (+68.8 nmol/L vs. < 1 yr), elapsed time < 4 h (+130.9 nmol/L vs. 4-12 h), and sampling time 6-10 AM (+96.4 nmol/L vs. 10 AM-2 PM). These variables independently predicted cortisol levels in pediatric patients during acute physiological stress.
测量皮质醇对于评估处于应激状态的患者的肾上腺功能至关重要；然而，由于各种临床因素，其值可能会波动。本研究旨在确定急性生理应激的儿科患者皮质醇水平的预测因素。纳入因急性疾病或术后护理紧急入住普通病房或儿科重症监护病房的儿童，排除疑似肾上腺功能异常或正在接受类固醇治疗的儿童。在登记后72小时内采集的血清样本中测量皮质醇，并探讨其与临床因素的关联。2021年8月至11月期间，共分析了来自217名患者的397份样本，皮质醇水平中位数为375 nmol/L（四分位间距：190 - 646 nmol/L）。采用混合效应模型的多元回归分析确定了以下皮质醇水平升高的预测因素：心率z评分（+43.8 nmol/L/分）、体温（+42.3 nmol/L/°C）、儿科早期预警系统评分（+44.3 nmol/L/分）、3至6岁年龄组（与<1岁相比，+68.8 nmol/L）、病程<4小时（与4 - 12小时相比，+130.9 nmol/L）以及采样时间为上午6 - 10点（与上午10点至下午2点相比，+96.4 nmol/L）。这些变量独立预测了急性生理应激期间儿科患者的皮质醇水平。
