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Initial observations regarding free cortisol quantification logistics among critically ill children.

Jerry J Zimmerman1, Ruth M Barker, Rhona Jack

  • 1Department of Pediatrics, Division of Critical Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA. jerry.zimmerman@seattlechildrens.org

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A new method for measuring free cortisol (FC) in critically ill children is fast and accurate. This technique provides real-time data to guide treatment for corticosteroid insufficiency.

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Area of Science:

  • Pediatric Endocrinology
  • Critical Care Medicine
  • Clinical Chemistry

Background:

  • Corticosteroid insufficiency diagnosis in critically ill patients is challenging.
  • Traditional free cortisol (FC) assessment methods like equilibrium dialysis (ED) are time-consuming and require large blood volumes.
  • Novel methods are needed for rapid FC quantification in pediatric critical care.

Purpose of the Study:

  • To evaluate a novel temperature-controlled centrifugal ultrafiltration with chemiluminescence immunoassay (CU/CI) for real-time FC measurement.
  • To compare CU/CI FC results with established methods: ED/radioimmunoassay (ED/RI) and liquid chromatography/mass spectrometry (LC/MS).
  • To assess FC levels in critically ill children and their correlation with corticotropin stimulation.

Main Methods:

  • Quantified total cortisol (TC) and FC using CU/CI, ED/RI, and LC/MS in healthy adults and 37 critically ill children.
  • Measured baseline and corticotropin-stimulated TC and FC levels.
  • Correlated FC measurements obtained by different methods.

Main Results:

  • FC levels were significantly higher in critically ill children compared to healthy adults, both at baseline and after corticotropin stimulation.
  • CU/CI accurately correlated with ED/RI and LC/MS for FC quantification, providing results in a fraction of the time.
  • Nearly 50% of critically ill children had FC levels below 2.0 μg/dL (55 nM).
  • Neither FC nor TC correlated with illness severity scores.

Conclusions:

  • Temperature-controlled centrifugal ultrafiltration with chemiluminescence immunoassay (CU/CI) offers a rapid (1-2 hours) and accurate method for FC quantification.
  • This technique shows high correlation with established gold-standard methods (ED/RI, LC/MS).
  • Real-time FC measurement using CU/CI has the potential to guide timely cortisol replacement therapy in critically ill children, pending further validation.