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Cortisol levels and corticosteroid administration fail to predict mortality in critical illness: the confounding effects of organ dysfunction and sex.
Arch Surg. 2005 Jul; 140(7):661-8; discussion 669.AS

Abstract

BACKGROUND

Corticosteroid supplementation based on plasma cortisol measurement was reported to decrease mortality in vasopressor-dependent critical illness.

HYPOTHESIS

Random levels or maximal increments of plasma cortisol measured after short adrenal stimulation may predict mortality independent of concurrent organ dysfunction or sex, and corticosteroid supplementation may decrease mortality in vasopressor-dependent critical illness.

DESIGN

An observational descriptive study.

PATIENTS

Critically ill patients receiving vasopressors for treatment of hemodynamic instability.

METHODS

Random levels (n = 522 patients) and maximal increments (n = 282 patients) of plasma cortisol were measured after 250 microg of adrenocorticotropic hormone was administered for short stimulation tests before patients received corticosteroid supplementation. The severity of acute illness was measured by sequential organ failure assessment.

MAIN OUTCOME MEASURE

Hospital mortality.

RESULTS

The overall mortality was 24%. A random plasma cortisol level of 15 microg/dL or less was associated with lower mortality than a random plasma cortisol level greater than 15 microg/dL in men (12% vs 26%, respectively; P<.01) and women (13% vs 31%, respectively; P<.01). A maximal plasma cortisol increment of 9 microg/dL or less increased mortality as compared with an increment greater than 9 microg/dL in men (31% vs 11%, respectively; P<.01) but not in women (30% vs 29%, respectively; P = .8). Random levels and maximal increments of plasma cortisol did not influence hospital mortality predicted by the sequential organ failure assessment score. Corticosteroids were given to 244 patients (47%) without an effect on mortality (mortality rate of 27% for patients given corticosteroids vs mortality rate of 22% for patients who did not receive corticosteroids; P = .6). Corticosteroids did not influence mortality when plasma cortisol was a random level of 15 microg/dL or less (mortality rate of 14% for patients who received corticosteroids vs mortality rate of 10% for those who did not receive corticosteroids; P = .4) or when plasma cortisol was a maximal increment of 9 microg/dL or less (mortality rate of 30% for patients who received corticosteroids vs mortality rate of 31% for patients who did not receive corticosteroids; P = .9).

CONCLUSIONS

Remote organ dysfunction and sex influenced mortality associated with cortisol levels measured in critical illness. Corticosteroid supplementation guided by arbitrary levels or increments of plasma cortisol in critical illness did not improve survival. Better guidelines for corticosteroid supplementation in critical illness should be developed to avoid potential adverse effects from unwarranted treatment.

Authors+Show Affiliations

Department of Critical Care Medicine, Mayo Clinic Hospital, Scottsdale, Ariz, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16027331

Citation

Rady, Mohamed Y., et al. "Cortisol Levels and Corticosteroid Administration Fail to Predict Mortality in Critical Illness: the Confounding Effects of Organ Dysfunction and Sex." Archives of Surgery (Chicago, Ill. : 1960), vol. 140, no. 7, 2005, pp. 661-8; discussion 669.
Rady MY, Johnson DJ, Patel B, et al. Cortisol levels and corticosteroid administration fail to predict mortality in critical illness: the confounding effects of organ dysfunction and sex. Arch Surg. 2005;140(7):661-8; discussion 669.
Rady, M. Y., Johnson, D. J., Patel, B., Larson, J., & Helmers, R. (2005). Cortisol levels and corticosteroid administration fail to predict mortality in critical illness: the confounding effects of organ dysfunction and sex. Archives of Surgery (Chicago, Ill. : 1960), 140(7), 661-8; discussion 669.
Rady MY, et al. Cortisol Levels and Corticosteroid Administration Fail to Predict Mortality in Critical Illness: the Confounding Effects of Organ Dysfunction and Sex. Arch Surg. 2005;140(7):661-8; discussion 669. PubMed PMID: 16027331.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cortisol levels and corticosteroid administration fail to predict mortality in critical illness: the confounding effects of organ dysfunction and sex. AU - Rady,Mohamed Y, AU - Johnson,Daniel J, AU - Patel,Bhavesh, AU - Larson,Joel, AU - Helmers,Richard, PY - 2005/7/20/pubmed PY - 2005/8/12/medline PY - 2005/7/20/entrez SP - 661-8; discussion 669 JF - Archives of surgery (Chicago, Ill. : 1960) JO - Arch Surg VL - 140 IS - 7 N2 - BACKGROUND: Corticosteroid supplementation based on plasma cortisol measurement was reported to decrease mortality in vasopressor-dependent critical illness. HYPOTHESIS: Random levels or maximal increments of plasma cortisol measured after short adrenal stimulation may predict mortality independent of concurrent organ dysfunction or sex, and corticosteroid supplementation may decrease mortality in vasopressor-dependent critical illness. DESIGN: An observational descriptive study. PATIENTS: Critically ill patients receiving vasopressors for treatment of hemodynamic instability. METHODS: Random levels (n = 522 patients) and maximal increments (n = 282 patients) of plasma cortisol were measured after 250 microg of adrenocorticotropic hormone was administered for short stimulation tests before patients received corticosteroid supplementation. The severity of acute illness was measured by sequential organ failure assessment. MAIN OUTCOME MEASURE: Hospital mortality. RESULTS: The overall mortality was 24%. A random plasma cortisol level of 15 microg/dL or less was associated with lower mortality than a random plasma cortisol level greater than 15 microg/dL in men (12% vs 26%, respectively; P<.01) and women (13% vs 31%, respectively; P<.01). A maximal plasma cortisol increment of 9 microg/dL or less increased mortality as compared with an increment greater than 9 microg/dL in men (31% vs 11%, respectively; P<.01) but not in women (30% vs 29%, respectively; P = .8). Random levels and maximal increments of plasma cortisol did not influence hospital mortality predicted by the sequential organ failure assessment score. Corticosteroids were given to 244 patients (47%) without an effect on mortality (mortality rate of 27% for patients given corticosteroids vs mortality rate of 22% for patients who did not receive corticosteroids; P = .6). Corticosteroids did not influence mortality when plasma cortisol was a random level of 15 microg/dL or less (mortality rate of 14% for patients who received corticosteroids vs mortality rate of 10% for those who did not receive corticosteroids; P = .4) or when plasma cortisol was a maximal increment of 9 microg/dL or less (mortality rate of 30% for patients who received corticosteroids vs mortality rate of 31% for patients who did not receive corticosteroids; P = .9). CONCLUSIONS: Remote organ dysfunction and sex influenced mortality associated with cortisol levels measured in critical illness. Corticosteroid supplementation guided by arbitrary levels or increments of plasma cortisol in critical illness did not improve survival. Better guidelines for corticosteroid supplementation in critical illness should be developed to avoid potential adverse effects from unwarranted treatment. SN - 0004-0010 UR - https://www.unboundmedicine.com/medline/citation/16027331/Cortisol_levels_and_corticosteroid_administration_fail_to_predict_mortality_in_critical_illness:_the_confounding_effects_of_organ_dysfunction_and_sex_ L2 - https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/archsurg.140.7.661 DB - PRIME DP - Unbound Medicine ER -