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Published on: August 25, 2014
Evaluation of endocrine function in children admitted to pediatric intensive care unit
Banu Küçükemre Aydın1, Demet Demirkol, Firdevs Baş
1Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey.
Insights
Pediatric critical illness shows no direct endocrine differences between survivors and non-survivors. However, cortisol, ACTH, IL-6, and IGFBP-3 correlate with risk scores, suggesting potential prognostic value in pediatric intensive care unit (PICU) patients.
Area of Science:
- Pediatric Endocrinology
- Critical Care Medicine
- Biomarkers
Background:
- Endocrinological disorders in critically ill children are understudied compared to adults.
- Understanding these disorders is crucial for improving outcomes in the pediatric intensive care unit (PICU).
- This study aimed to define endocrinological changes and their prognostic impact in PICU patients.
Purpose of the Study:
- To characterize endocrine profiles in critically ill children.
- To investigate the relationship between endocrine parameters and patient prognosis.
- To identify potential prognostic biomarkers in the PICU setting.
Main Methods:
- Forty PICU patients (mean age 5.1 years) were enrolled.
- Hormonal assays (cortisol, ACTH, prolactin, GH, GHBP, IGFBP-3) and IL-6 levels were measured at admission, 24h, and 48h.
- Disease severity was assessed using Pediatric Risk of Mortality (PRISM) and Pediatric Logistic Organ Dysfunction (PELOD) scores.
Main Results:
- No significant differences in endocrine parameters or IL-6 were found between survivors and non-survivors.
- PRISM and PELOD scores were higher in non-survivors.
- Baseline IGFBP-3 negatively correlated with PRISM; cortisol at 24h positively correlated with PRISM. ACTH and 24h cortisol best explained PRISM scores. IL-6 at 24h showed a weak positive correlation with PELOD scores.
Conclusions:
- While individual endocrine parameters did not differ between survivors and non-survivors, associations were observed with severity scores.
- Cortisol, ACTH, IL-6, and IGFBP-3 show correlations with PRISM and PELOD scores.
- These endocrine and inflammatory markers may serve as valuable prognostic indicators in critically ill children.
Background:
Although studied widely in adulthood, little is known about endocrinological disorders during critical illnesses in childhood. The aims of this study were to define the endocrinological changes in patients admitted to pediatric intensive care unit (PICU) and to identify their effects on prognosis.
Methods:
Forty patients with a mean age of 5.1 years admitted to PICU were enrolled in the study. Blood samples were taken at admission and at 24 and 48 h to measure cortisol, adrenocorticotropic hormone (ACTH), prolactin, growth hormone (GH), GH binding protein (GHBP), insulin-like growth factor-binding protein-3 (IGFBP-3) and interleukin-6 (IL-6). The severity of the patient's condition was assessed using pediatric risk of mortality (PRISM) and pediatric logistic organ dysfunction (PELOD) scores.
Results:
PRISM and PELOD scores were significantly higher in non-survivors. Cortisol, ACTH, prolactin, GH, GHBP, IGFBP-3 and IL-6 were not significantly different between the survivors and non-survivors. There was a negative correlation between baseline IGFBP-3 and PRISM scores. A positive correlation was seen between cortisol level at 24 h and PRISM score. On multivariate linear regression analysis, PRISM score was best explained by ACTH and cortisol at 24 h. A positive weak correlation was detected between IL-6 at 24 h and PELOD scores.
Conclusions:
Although there was no difference between survivors and non-survivors regarding the studied endocrine parameters, there were associations between cortisol, ACTH, IL-6 and IGFBP-3 and risk assessment scores, and, given that these scores correlated with mortality, these parameters might be useful as prognostic factors.
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