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Relation between Baseline Total Serum Cortisol Level and Outcome in Pediatric Intensive Care Unit

Osama E Bekhit1, Shereen A Mohamed2, Remon M Yousef3

  • 1Pediatric department, Faculty of Medicine, Fayoum University, Fayoum, Egypt. dr_elsayed71@yahoo.com.

Scientific Reports
|April 14, 2019
PubMed

Insights

Elevated cortisol levels in pediatric intensive care unit (PICU) patients predict mortality. While critical illness-related corticosteroid insufficiency (CIRCI) is common, high cortisol levels, not low, were linked to worse outcomes.

Area of Science:

  • Pediatric Critical Care Medicine
  • Endocrinology
  • Clinical Research

Background:

  • Cortisol, a stress hormone, plays a role in critical illness.
  • Critical illness-related corticosteroid insufficiency (CIRCI) involves low cortisol levels.
  • The relationship between basal cortisol levels and outcomes in pediatric intensive care unit (PICU) patients requires further investigation.

Purpose of the Study:

  • To assess basal total serum cortisol levels in pediatric patients admitted to the PICU.
  • To determine the association between basal total serum cortisol levels and patient outcomes.
  • To identify predictors of mortality in critically ill children.

Main Methods:

  • Prospective cohort study including 81 children over 6 months old admitted to the PICU.
  • Assessed early morning total serum cortisol levels.
  • Utilized Pediatric Risk of Mortality III (PRISM-III) score for illness severity.
  • Collected data on mechanical ventilation duration, inotropic support, length of stay, and mortality.

Main Results:

  • Patients with elevated total serum cortisol levels had a significantly higher PRISM-III score.
  • Elevated total serum cortisol levels were associated with a significantly higher mortality rate.
  • Multivariate analysis identified high total serum cortisol level and PRISM-III score as significant predictors of mortality.
  • CIRCI was prevalent but not associated with increased mortality.

Conclusions:

  • Elevated total serum cortisol levels and high PRISM-III scores are significant predictors of mortality in the PICU.
  • High cortisol levels, rather than low levels (CIRCI), are associated with adverse outcomes in this pediatric population.

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