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Hormonal status in protracted critical illness and in-hospital mortality
Tarek Sharshar1, Sylvie Bastuji-Garin, Andrea Polito
1Department of Intensive Care Medicine, AP-HP, Raymond Poincaré Hospital, University Versailles Saint-Quentin en Yvelines, 104 bd Raymond Poincaré, Garches F-92380, France. tarek.sharshar@rpc.aphp.fr
Introduction:
The aim of this study was to determine the relationship between hormonal status and mortality in patients with protracted critical illness.
Methods:
We conducted a prospective observational study in four medical and surgical intensive care units (ICUs). ICU patients who regained consciousness after 7 days of mechanical ventilation were included. Plasma levels of insulin-like growth factor 1 (IGF-1), prolactin, thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, estradiol, progesterone, testosterone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS) and cortisol were measured on the first day patients were awake and cooperative (day 1). Mean blood glucose from admission to day 1 was calculated.
Results:
We studied 102 patients: 65 men and 37 women (29 of the women were postmenopausal). Twenty-four patients (24%) died in the hospital. The IGF-1 levels were higher and the cortisol levels were lower in survivors. Mean blood glucose was lower in women who survived, and DHEA and DHEAS were higher in men who survived.
Conclusions:
These results suggest that, on the basis of sex, some endocrine or metabolic markers measured in the postacute phase of critical illness might have a prognostic value.