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Intensive Care Med. 2007 Oct;33(10):1746-53. Epub 2007 Jun 9.

Evidence of altered cortisol metabolism in critically ill patients: a prospective study.

Author information

  • 1Department of Intensive Care, Princess Alexandra and Wesley Hospitals, University of Queensland, 4102, Queensland, Australia. bala_venkatesh@health.qld.gov.au

Abstract

CONTEXT:

Changes in cortisol metabolism due to altered activity of the enzyme 11beta-hydroxysteroid dehydrogenase (11beta-HSD) have been implicated in the pathogenesis of hypertension, obesity and the metabolic syndrome. No published data exist on the activity of this enzyme in critical illness.

OBJECTIVE:

To investigate cortisol metabolism in critically ill patients utilising plasma cortisol: cortisone ratio as an index of 11beta-HSD activity.

SETTING:

Tertiary level intensive care unit.

PATIENTS:

Three cohorts of critically ill patients: sepsis (n = 13); multitrauma (n = 20); and burns (n = 19).

MAIN OUTCOME MEASURES:

Serial plasma cortisol: cortisone ratios.

MEASUREMENTS AND MAIN RESULTS:

Plasma total cortisol cortisone ratios were determined serially after admission to the intensive care unit. As compared with controls, the plasma cortisol:cortisone ratio was significantly elevated in the sepsis and trauma cohorts on day 1 (22 +/- 9, p = 0.01, and 23 +/- 19, p = 0.0003, respectively) and remained elevated over the study period. Such a relationship was not demonstrable in burns. The ratio was significantly correlated with APACHE II (r = 0.77, p = 0.0008) and Simplified Acute Physiology Score (r = 0.7, p = 0.003) only on day 7 and only in the burns cohort. There were no significant correlations observed between total plasma cortisol or cortisone and sickness severity in the sepsis and trauma cohorts.

CONCLUSIONS:

In critically ill patients, there is evidence of altered cortisol metabolism due to an increase in 11beta-HSD activity as demonstrated by an elevation of plasma cortisol: cortisone ratios. Further studies with larger sample sizes specifically designed to examine altered tissue 11beta-HSD activity and its clinical significance and correlation with outcome are warranted.

PMID:
17558491
[PubMed - indexed for MEDLINE]
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