Endocrine Abstracts

Introduction: Endocrinological and metabolic changes can occur in critically ill patients, which may affect the prognosis and outcome. The hypothalamic–anterior–pituitary axis (HPA) plays a crucial role in the endocrine regulation of metabolic and immunological homeostasis. In this prospective study, we evaluated the pituitary–adrenal–gonadal–thyroid axis in the adult Intensive Care Unit (ICU) patients,their outcome, the association between these hormonal changes and ‘The Acute Physiology and Chronic Health Evaluation II score (APACHE II)’, Sequential Organ Failure Assessment (SOFA), length of hospitalisation and mortality.

Methods: Patients hospitalised in adult ICU (not for trauma or operation) between January 2014 and January 2015 were enrolled in this study. Severity of illness was assessed by APACHE II and SOFA on admission to the ICU and 15 days later. Blood samples were collected within the first 4 h of ICU admission and 15 days later for measurement of anterior pituitary and end organ hormones.

Results: Total patient number was 157. Eighty-five patients were in survival (S), 72 patients were in the non-survival (NS) group. In the NS group, patients’ mean age, APACHE II and SOFA scores at the admission were significantly higher. In the NS group median GH, E₂, and cortisol levels were significantly higher whereas median FSH, LH, fT₃, and fT₄ were lower. Fifteen days after admission, there was significant increase in median IGF1 and ACTH levels and decrease in median cortisol and SOFA scores compared to baseline values. Strongest predictors for mortality were found to be hospitalization length, SOFA score, deltaTSH, and age. None of the other endocrine parameters had an effect on mortality.

Conclusion: In critical illness, activation of the HPA and the cortisol response are essential for survival. Combinations of endocrine parameters may provide better indices than measurement of a single hormone or an APACHE II-based score.