López-Izquierdo Raúl, Ingelmo-Astorga Elisa A, Del Pozo Vegas Carlos, Gracia Villar Santos, Dzul López Luis Alonso, Aparicio Obregón Silvia, Calderon Iglesias Rubén, Sanz-García Ancor, Martín-Rodríguez Francisco
Emergency Department. Hospital Universitario Rio Hortega, Gerencia Regional de Salud de Castilla y León, Valladolid, Spain.
Faculty of Medicine. Universidad de Valladolid, Valladolid, Spain.
Commun Med (Lond). 2025 Jul 23;5(1):308. doi: 10.1038/s43856-025-01020-4.
Nowadays, there is no correlation between levels of cortisol and pain in the prehospital setting. The aim of this work was to determine the ability of prehospital cortisol levels to correlate to pain. Cortisol levels were compared with those of the numerical rating scale (NRS).
This is a prospective observational study looking at adult patients with acute disease managed by Emergency Medical Services (EMS) and transferred to the emergency department of two tertiary care hospitals. Epidemiological variables, vital signs, and prehospital blood analysis data were collected. A total of 1516 patients were included, the median age was 67 years (IQR: 51-79; range: 18-103) with 42.7% of females. The primary outcome was pain evaluation by NRS, which was categorized as pain-free (0 points), mild (1-3), moderate (4-6), or severe (≥7). Analysis of variance, correlation, and classification capacity in the form area under the curve of the receiver operating characteristic (AUC) curve were used to prospectively evaluate the association of cortisol with NRS.
The median NRS and cortisol level are 1 point (IQR: 0-4) and 282 nmol/L (IQR: 143-433). There are 584 pain-free patients (38.5%), 525 mild (34.6%), 244 moderate (16.1%), and 163 severe pain (10.8%). Cortisol levels in each NRS category result in p < 0.001. The correlation coefficient between the cortisol level and NRS is 0.87 (p < 0.001). The AUC of cortisol to classify patients into each NRS category is 0.882 (95% CI: 0.853-0.910), 0.496 (95% CI: 0.446-0.545), 0.837 (95% CI: 0.803-0.872), and 0.981 (95% CI: 0.970-0.991) for the pain-free, mild, moderate, and severe categories, respectively.
Cortisol levels show similar pain evaluation as NRS, with high-correlation for NRS pain categories, except for mild-pain. Therefore, cortisol evaluation via the EMS could provide information regarding pain status.
目前，在院前环境中，皮质醇水平与疼痛之间不存在相关性。这项研究的目的是确定院前皮质醇水平与疼痛的关联能力。将皮质醇水平与数字评分量表（NRS）的水平进行比较。
这是一项前瞻性观察性研究，观察对象为成年急性病患者，由紧急医疗服务（EMS）进行处理并转运至两家三级护理医院的急诊科。收集流行病学变量、生命体征和院前血液分析数据。共纳入1516例患者，中位年龄为67岁（四分位间距：51 - 79岁；范围：18 - 103岁），女性占42.7%。主要结局是通过NRS进行疼痛评估，分为无痛（0分）、轻度（1 - 3分）、中度（4 - 6分）或重度（≥7分）。采用方差分析、相关性分析以及以受试者工作特征（AUC）曲线下面积形式的分类能力分析，前瞻性评估皮质醇与NRS的关联。
NRS的中位数和皮质醇水平分别为1分（四分位间距：0 - 4分）和282 nmol/L（四分位间距：143 - 433 nmol/L）。无痛患者有584例（38.5%），轻度疼痛患者525例（34.6%），中度疼痛患者244例（16.1%），重度疼痛患者163例（10.8%）。各NRS类别中的皮质醇水平导致p < 0.001。皮质醇水平与NRS之间的相关系数为0.87（p < 0.001）。皮质醇将患者分类到各NRS类别的AUC分别为：无痛类别0.882（95%置信区间：0.853 - 0.910），轻度疼痛类别0.496（95%置信区间：0.446 - 0.545），中度疼痛类别0.837（95%置信区间：0.803 - 0.872），重度疼痛类别0.981（95%置信区间：0.970 - 0.991）。
皮质醇水平与NRS显示出相似的疼痛评估结果，除轻度疼痛外，与NRS疼痛类别具有高度相关性。因此，通过EMS进行皮质醇评估可提供有关疼痛状态的信息。
