BES2018 BES 2018 Adrenocortical function during prolonged critical illness and beyond: a prospective observational study (1 abstracts)
Adrenocortical function during prolonged critical illness and beyond: a prospective observational study
Peeters Bram 1 , Meersseman Philippe 1, , Vander Perre Sarah 1 , J Wouters Pieter 1 , Vanmarcke Dimitri 1 , Debaveye Yves 1 , Billen Jaak 3 , Vermeersch Pieter 3 , Langouche Lies 1 & Van den Berghe Greet 1
1Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium; 2Medical Intensive Care Unit, Department of General Internal Medicine, UZ Leuven, Leuven, Belgium; 3Department of Laboratory Medicine, UZ Leuven, Leuven, Belgium.
Aim of the work: The time courses of ACTH, (free) cortisol and cortisol metabolites beyond the first week of critical illness and upon recovery have not been documented. We studied adrenocortical function over time in relation to critical illness duration and presence of sepsis/septic shock, to initiation of glucocorticoid treatment, and to recovery/death.
Methods: Patients still in ICU on day 7 (N=392) and 20 matched healthy subjects were included. Morning blood and 24h-urine were collected daily and cosyntropin tests (Synacthen®, 250 μg) performed weekly, repeated 7 days after ICU-discharge.
Main results: In patients who remained free of glucocorticoid treatment until ICU-day 28 (N=347), plasma ACTH remained low/normal, whereas free cortisol remained high (P≤0.002) explained by reduced binding proteins (P≤0.02) and suppressed cortisol breakdown (P≤0.001). Beyond ICU-day 28 (N=64 long-stayers), plasma ACTH and (free)cortisol became comparable to healthy subjects. Long-stay-patients always showed low incremental total (P≤0.001), but normal incremental free, cortisol responses to weekly cosyntropin-tests, explained by low binding proteins whereby increased cortisol distribution volume. Sepsis/septic shock patients were not different from others, patients subsequently receiving glucocorticoids (N=45) were not different from those who did not, and non-survivors were distinguishable from survivors only by higher (free) cortisol. One week after ICU-discharge, plasma ACTH and (free)cortisol increased to supra-normal levels (P≤0.006).
Conclusions: Low plasma binding proteins and suppressed cortisol breakdown in prolonged critical illness confound interpretation of cosyntropin-test results. The absence of elevated ACTH and free cortisol beyond ICU-day 28, followed by a clear rise after ICU-discharge, suggests central adrenocortical suppression that could predispose long-stay ICU patients to adrenal insufficiency.
Volume 57
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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