Increased total serum random cortisol levels predict mortality in critically ill trauma patients

Area of Science:

• Critical Care Medicine
• Endocrinology
• Trauma Surgery

Background:

• The hypothalamopituitary adrenal axis function is debated in critical illness.
• Limited research exists on serum cortisol's prognostic value in trauma patients.
• Adrenal insufficiency criteria remain controversial, especially in severe injury.

Purpose of the Study:

• To investigate the association between serum cortisol levels and mortality in critically ill trauma patients.
• To determine if serum cortisol can serve as a predictive biomarker for in-hospital death.

Main Methods:

• Retrospective review of 242 critically ill trauma patients admitted to the ICU.
• Serum cortisol levels were measured within the first seven days of hospitalization.
• In-hospital mortality was the primary outcome; Injury Severity Score was also analyzed.

Main Results:

• Nonsurvivors exhibited significantly higher mean serum cortisol levels (28.7 ± 15.80 μg/dL) than survivors (22.9 ± 12.35 μg/dL).
• Cortisol levels ≥ 30 μg/dL increased mortality risk (Odds Ratio 2.7).
• Higher cortisol levels were observed in nonsurvivors with lower Injury Severity Scores (<25).

Conclusions:

• Elevated serum cortisol levels are predictive of mortality in critically ill trauma patients.
• Serum cortisol demonstrates 77% accuracy in differentiating survivors from nonsurvivors.
• Further research is needed to explore therapeutic modifications targeting serum cortisol levels.