The Delayed Cortisol Peak Effect After Severe Burn Injury: A Prospective Observational Study

Area of Science:

• Endocrinology
• Trauma Care
• Critical Care Medicine

Background:

• Acute adrenal insufficiency is poorly understood in burn patients compared to trauma and septic shock.
• Severe burn injuries can significantly impact endocrine function and stress response.
• There is a need to characterize the cortisol stress response in critically ill burn patients.

Purpose of the Study:

• To investigate the incidence and relevance of acute adrenal insufficiency in severe burn injuries.
• To analyze the spontaneous cortisol stress response in burn patients during the initial week post-injury.
• To identify factors correlating with cortisol levels in burn patients.

Main Methods:

• Prospective observational study of burn patients admitted to an Intensive Care Unit.
• Daily serum cortisol measurements from day 1 to day 7 post-burn.
• Collected data included burn severity (TBSA, ABSI), inhalation trauma, and inflammatory markers (IL-6, leukocytes, CRP).

Main Results:

• Mean cortisol levels remained within physiological range for the first 4 days, with a significant increase observed from day 5 to 7.
• Total body surface area (TBSA) burned, Abbreviated Burn Severity Index (ABSI), and third-degree burns did not predict cortisol levels.
• Interleukin-6 (IL-6) and leukocyte counts significantly correlated with cortisol levels.

Conclusions:

• Burn patients exhibit a relative cortisol deficit in the acute phase.
• Findings support the use of early, low-dose hydrocortisone supplementation in severe burn injury management.
• Further research is warranted to optimize stress hormone management in burn care.