Bamberg Maximilian, Maros Máté Elod, Menger Maximilian Michael, Thiel Johannes Tobias, Illg Claudius, Viergutz Tim, Kalenka Armin, Fontana Johann
Department of Anesthesiology and Intensive Care Medicine, BG Trauma Center Tübingen, Tübingen, Germany.
Department of Biomedical Informatics at the Center for Preventive Medicine and Digital Health (CPD-BW), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
In Vivo. 2025 Mar-Apr;39(2):877-884. doi: 10.21873/invivo.13891.
BACKGROUND/AIM: In contrast to patients with major trauma and septic shock, little is known about the incidence and relevance of acute adrenal insufficiency among patients with burn injuries. Addressing this data gap, the current study was designed to analyze the spontaneous cortisol stress response after severe burn injury.
The study was designed as a prospective observational analysis. From 09/2023 until 06/2024, all patients admitted to the Intensive Care Unit of the BG Tübingen Burn Center were included. The daily cortisol levels were determined in combination with the daily routine laboratory values between 5 and 6 a.m. from day 1 until 7. The data acquisition included the following parameters: Age, sex, total body surface area (TBSA) burned, Abbreviated Burn Severity Index (ABSI), tracheotomy, inhalation trauma, serum cortisol, interleukin-6 (IL-6), leukocyte count and C-reactive protein (CRP).
A total of 19 patients with a mean TBSA burned of 33.58±22.68% were included. The mean cortisol values from days 1 to 4 stayed within the physiological range with a delayed significant increase from day 5 until 7 (day 1: 503.3±279.5 day 7: 812.5±330.6 nmol/l; physiological range=130-630 nmol/l). TBSA burned, ABSI, and third-degree injury failed to demonstrate predictive potential, while the IL-6 and leukocyte courses demonstrated significant correlation with the cortisol course.
The findings of the current study align with previous studies suggesting a relative cortisol deficit during the acute stages of severe burn injury, supporting the treatment approach of early low-dose hydrocortisone supplementation in patients with severe burn injury.
背景/目的：与重大创伤和感染性休克患者不同，对于烧伤患者急性肾上腺功能不全的发生率和相关性知之甚少。为填补这一数据空白，本研究旨在分析严重烧伤后自发性皮质醇应激反应。
本研究设计为前瞻性观察分析。纳入2023年9月至2024年6月期间入住图宾根BG烧伤中心重症监护病房的所有患者。从第1天至第7天，每天早上5点至6点结合日常常规实验室值测定皮质醇水平。数据采集包括以下参数：年龄、性别、烧伤总面积（TBSA）、简化烧伤严重程度指数（ABSI）、气管切开术、吸入性损伤、血清皮质醇、白细胞介素-6（IL-6）、白细胞计数和C反应蛋白（CRP）。
共纳入19例患者，平均烧伤TBSA为33.58±22.68%。第1天至第4天的平均皮质醇值保持在生理范围内，从第5天至第7天有延迟的显著升高（第1天：503.3±279.5；第7天：812.5±330.6 nmol/l；生理范围=130 - 630 nmol/l）。烧伤TBSA、ABSI和三度损伤未显示出预测潜力，而IL-6和白细胞病程与皮质醇病程显示出显著相关性。
本研究结果与先前研究一致，表明严重烧伤急性期存在相对皮质醇缺乏，支持对严重烧伤患者早期补充低剂量氢化可的松的治疗方法。
