scholarly journals Occurrence of Adrenal Suppression in Patients Having Sepsis in Indian Population and Impact of Corticosteroid Supplementation on Its Overall Survival

2021 ◽  
Author(s):  
Kamalakanta Swain ◽  
Sikata Nanda ◽  
Sarat Chandra Jayasingh ◽  
Sidharth Sraban Routray ◽  
Avijit Swain ◽  
...  
Keyword(s):  
Septic Shock ◽  
Overall Survival ◽  
Cortisol Level ◽  
Leucocyte Count ◽  
Serum Cortisol ◽  
Adrenal Suppression ◽  
Serum Cortisol Level ◽  
Total Leucocyte Count ◽  
Group A ◽  
Group B

Abstract Objective Our aim was to estimate the occurrence of adrenal suppression in critically ill patients with septic shock who have got admission in intensive care unit and to evaluate the effectiveness of hydrocortisone in these patients in relation to mortality of patient, development of septic shock, and effect on total leucocyte count. Methods Serum cortisol was measured in 120 patients with sepsis. Patients with decreased cortisol level were split in to two groups (group A and B). Group A received 50 mg of hydrocortisone 6 hourly and group B was given matching placebo. At day 7, serum cortisol level was estimated for both A and B groups. The results were calculated and compared with relation to incidence of adrenal insufficiency, development of septic shock, effect on total leucocyte count, and survival at 28 days. Results The occurrence of adrenal suppression in patients having sepsis in our study was 44 out of 120 patients, that is, 36.6%. After supplementation of corticosteroid for 7 days the mean value of serum cortisol of group A was 40.38 ± 8.44 µg/dL and group B was 24.30 ± 6.47 µg/dL (p < 0.001). At day 7, in group A, 22.7% developed septic shock, whereas in group B, 36.4% developed septic shock (p < 0.001). In group A and B, mortality rate of the patients at 28 days was 18.2 and 22.7%, respectively. Conclusion Hydrocortisone supplementation in critically ill patients with low random basal serum cortisol level with sepsis does not significantly improve the overall survival.

scholarly journals Different adrenal response of critically ill neonates; An Egyptian model

2020 ◽  
Author(s):  
Wafaa Osman ◽  
suzan abd razek
Keyword(s):  
Septic Shock ◽  
Critically Ill ◽  
Drug Administration ◽  
Cortisol Level ◽  
Serum Cortisol ◽  
Inotropic Support ◽  
Serum Cortisol Level ◽  
Minus Sign ◽  
Group A ◽  
Critically Ill Neonates

Background: Adequate adrenocortical function is essential for survival of critically ill neonates. Although most of them display elevated plasma cortisol concentrations, which reflects activation of the hypothalamic pituitary adrenal axis (HPA), yet; adrenocortical insufficiency is seen in septic shock. Objectives: Evaluate the HPA response in critically ill neonates with shock. Subjects:this prospective observational study included a total of 60 neonates divided into 3 groups;(A)30 critical ill neonates with septic shock on inotropic support, (B)15 patients with sepsis who did not need inotropic support and(C) control group(n=15). Methods: Adrenal functions were evaluated by taking a single diurnal ACTH reading and two readings for serum cortisol level (diurnal and nocturnal). Results: Gram negative organism was more prevalent among the patients; 53%, 63% in groups A and B respectively. Group A showed Significant statistical hypotension before vasopressor drug administration (p<0.001) as compared to both groups. Group A showed Significant statistical improvement of blood pressure after vasopressor drug administration (p<0.001) as compared to both groups B, C. Serum cortisol was significantly higher in group A(57.21 plus-or-minus sign 24.31) and B (48.01 plus-or-minus sign 18.27 ), while it was lower in group C(19.57plus-or-minus sign 16.05 ) . A highly statistically significant rise of serum cortisol level( p=0.000) and ACTH(p=0.000) in group A when was compared to the other two groupsConclusion: This study introduced a new pattern of serum cortisol response in neonates ranging from very high cortisol level to a near normal values; highlighting a state of glucocorticoid resistance in neonates and relative adrenal insufficiency.

Serum Cortisol: A Predictor of Mortality in Sepsis?

1992 ◽  
Vol 7 (2) ◽  
pp. 84-89 ◽  
Author(s):  
Deborah J. Cook ◽  
Gordon H. Guyatt ◽  
William McIlroy ◽  
Brenda K. Reeve ◽  
Andrew Willan ◽  
...  
Keyword(s):  
Septic Shock ◽  
Independent Predictor ◽  
Serum Cortisol ◽  
Simplified Acute Physiology Score ◽  
Serum Lactate ◽  
Group A ◽  
Cortisol Levels ◽  
Lactate Levels ◽  
Group B ◽  
Severe Septic Shock

To evaluate the pattern and predictive value of serum cortisol levels in severe septic shock, we studied 20 consecutive critically ill patients with severe sepsis. Serum cortisol levels were measured at time of diagnosis, at 12 and 24 hours, and daily for 5 days. Underlying diagnoses included pneumonia (n = 9), urosepsis (n = 5), peritonitis (n = 4), and cellulitis (n = 2). Two patterns of cortisol secretion were identified. In Group A, serum cortisol levels were greater than 400 nmol/L and gradually decreased (n = 14). In Group B, levels were less than 400 nmol/L and remained below normal (n = 6). In Group A, 2 patients died (14.3%), whereas in Group B, 5 died (83.3%) (p < 0.05). The Simplified Acute Physiology Score (SAPS) was higher, intitial serum cortisol levels were lower, and serum lactate levels were higher in the nonsurvivors. In a logistical regression model, SAPS was the only independent predictor of death; when this variable was removed from the model, decreased initial serum cortisol was also predictive. Increased serum lactate was strongly associated with mortality. There appears to be an association between decreased initial serum cortisol and mortality in patients with severe septic shock.

scholarly journals Serum cortisol level in indian patients with severe sepsis/septic shock

2017 ◽  
Vol 10 (4) ◽  
pp. 194 ◽  
Author(s):  
Naveet Wig ◽  
Ragavendra Suresh ◽  
PrasanKumar Panda ◽  
VP Jyotsna ◽  
PK Chaturvedi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Cortisol Level ◽  
Serum Cortisol ◽  
Serum Cortisol Level ◽  
Indian Patients

Nighttime serum cortisol level for diagnosis of hypercortisolism in hospitalized patients

2019 ◽  
Author(s):  
Liana Khatsimova ◽  
Uliana Tsoy ◽  
Natalia Kuritsyna ◽  
Elena Grineva ◽  
Elena Litvinenko ◽  
...  
Keyword(s):  
Cortisol Level ◽  
Serum Cortisol ◽  
Hospitalized Patients ◽  
Serum Cortisol Level

Serum Cortisol Abnormalities after Craniocerebral Trauma

Neurosurgery ◽  
1979 ◽  
Vol 5 (5) ◽  
pp. 559-565 ◽  
Author(s):  
Paul Steinbok ◽  
Gordon Thompson
Keyword(s):  
Head Injury ◽  
Cortisol Level ◽  
Diurnal Rhythm ◽  
Elevated Serum ◽  
Craniocerebral Trauma ◽  
Serum Cortisol ◽  
Feedback Mechanism ◽  
Serum Cortisol Level ◽  
Skull Fractures ◽  
Middle Fossa

Abstract Serial estimations of serum cortisol were performed in 49 patients with craniocerebral trauma. Abnormalities of serum cortisol, including alterations in diurnal rhythm and elevations of serum cortisol level, occurred in 21 patients. The frequency and severity of the abnormalities correlated with the severity of the head injury, and there was a trend suggesting that middle fossa basal skull fractures predisposed to cortisol abnormalities. A further 6 patients were studied to assess the effects of exogenous dexamethasone, and in all patients there was suppression of elevated serum cortisol levels by the dexamethasone. The findings suggest that hypercortisolemia after head injury is related to an alteration rather than an abolition of the normal feedback mechanism.

scholarly journals Effects of Surgical Stress on Serum Cortisol Level: A Comparative Study between Elective and Emergency Surgery

1970 ◽  
Vol 2 ◽  
pp. 28-33
Author(s):  
SM Selimuzzaman ◽  
Noorzahan Begum ◽  
Nadira Islam ◽  
Shelina Begum
Keyword(s):  
Surgical Treatment ◽  
Cortisol Level ◽  
Surgical Stress ◽  
Serum Cortisol ◽  
Study Groups ◽  
Serum Cortisol Level ◽  
Control Group ◽  
Surgical Interventions ◽  
Group I ◽  
Healthy Control

The study was designed to observe the effects of surgical stress on serum level of cortisol in patients undergoing surgical treatment and to find out any differences in hormonal response between elective and emergency surgical procedures. A total number of 60 male subjects aged between 18 and 45 years were included in the study. Of them, 20 were healthy control (Group I), 20 underwent elective surgical treatment (Group II) and emergency surgical interventions were applied in rest 20 subjects (Group III). Study Groups were further divided into subgroups A (preoperative samples were collected 1- hour before operation), B (postoperative samples were collected 1-hour after the end of the operation) and C (postoperative samples were collected 24-hours after operation).Serum cortisol level was estimated by invitro-immunolytic test.Statistical analysis was done by paired, unpaired ‘t' test and regression analysis. The preoperative mean serum cortisol concentration in elective surgical cases was almost similar to that of healthy control. On the contrary, in the emergency surgical cases, a significantly increased mean cortisol level were observed (I vs IIIA and IIA vs IIIA; P < 0.05). The serum cortisol concentrations were increased both in elective and emergency surgical cases after operations but the magnitude of rise was more marked in emergency group of patients (IIB vs IIIB; P < 0.05). Therefore, this study reveals that surgical intervention causes increase in serum cortisol which is more marked in emergency procedure. Key Words: Stress; Cortisol; Surgery DOI:10.3329/jbsp.v2i0.981 J Bangladesh Soc Physiol. 2007 Dec;(2): 28-33.

scholarly journals Prognosis in young women less than 40 years of age with brain metastasis from breast cancer

2020 ◽  
Vol 27 (1) ◽  
Author(s):  
A. Mustillo ◽  
J. P. Ayoub ◽  
D. Charpentier ◽  
L. Yelle ◽  
M. Florescu
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Brain Metastasis ◽  
Young Women ◽  
Young Patients ◽  
Radiation Technology ◽  
Group A ◽  
Group B ◽  
Initial Metastasis ◽  
The Brain

Background Brain metastasis from breast cancer (bca) in young women is doubly devastating because both quality of life and life expectancy are significantly reduced. With new radiation technology and drugs that have emerged, survival is expected to increase for these young women.Methods Using the oacis and sardo patient databases, we identified 121 patients diagnosed with bca and brain metastasis between 2006 and 2016 at the University of Montreal Hospital Centre. Those patients were divided into Group A, patients who developed brain metastasis during the evolution of metastatic bca, and Group B, patients whose first metastasis was to the brain. For each group, we compared young patients (<40 years of age) with older patients (≥40 years of age).Results Among the 121 patients with brain metastasis, median overall survival (mos) was significantly longer for those less than 40 years of age than for those 40 or more years of age (18 months vs. 4 months, p < 0.001). With respect to the timing of brain metastasis, survival was significantly longer in Group B than in Group A (7 months vs. 4 months, p = 0.032). In Group A, mos was significantly longer for patients less than 40 years of age than for patients 40 or more years of age (18 months vs. 3 months, p = 0.0089). In Group B, the 2-year overall survival rate was 57% for patients less than 40 years of age and 12% for those 40 or more years of age (mos: not reached vs. 7 months; p = 0.259).Conclusions In our single-centre retrospective cohort of women with brain metastasis from bca, prognosis was better for young women (<40 years) than for older women (≥40 years). Survival was also longer for patients whose initial metastasis was to the brain than for patients whose brain metastasis developed later in the disease course. In patients who received systemic treatment, median survival remained significantly higher in women less than 40 years of age. Further studies are needed to validate those results.

scholarly journals Subphenotypes in Patients with Septic Shock Receiving Vitamin C, Hydrocortisone, and Thiamine: A Retrospective Cohort Analysis

Nutrients ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 2976 ◽  
Author(s):  
Won-Young Kim ◽  
Jae-Woo Jung ◽  
Jae Chol Choi ◽  
Jong Wook Shin ◽  
Jae Yeol Kim
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Vitamin C ◽  
Blood Cell ◽  
White Blood Cell ◽  
Blood Cell Count ◽  
Group A ◽  
Group B ◽  
Group D

This study aimed to identify septic phenotypes in patients receiving vitamin C, hydrocortisone, and thiamine using temperature and white blood cell count. Data were obtained from septic shock patients who were also treated using a vitamin C protocol in a medical intensive care unit. Patients were divided into groups according to the temperature measurements as well as white blood cell counts within 24 h before starting the vitamin C protocol. In the study, 127 patients included who met the inclusion criteria. In the cohort, four groups were identified: “Temperature ≥37.1 °C, white blood cell count ≥15.0 1000/mm3” (group A; n = 27), “≥37.1 °C, <15.0 1000/mm3” (group B; n = 30), “<37.1 °C, ≥15.0 1000/mm3” (group C; n = 35) and “<37.1 °C, <15.0 1000/mm3” (group D; n = 35). The intensive care unit mortality rates were 15% for group A, 33% for group B, 34% for group C, and 49% for group D (p = 0.051). The temporal improvement in organ dysfunction and vasopressor dose seemed more apparent in group A patients. Our results suggest that different subphenotypes exist among sepsis patients treated using a vitamin C protocol, and clinical outcomes might be better for patients with the hyperinflammatory subphenotype.

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