Abstract

VERA DE RUFFINELLI, J  and  FACULTAD DE CIENCIAS MEDICAS - UNIVERSIDAD NACIONAL DE ASUNCION. Segunda Cátedra de Clínica Médica et al. Adrenal response in critically ill patients of the Hospital de Clínicas of Asuncion, Paraguay. An. Fac. Cienc. Méd. (Asunción) [online]. 2009, vol.42, n.1, pp.27-36. ISSN 1816-8949.

ABSTRACT The prognosis of critically ill patients mainly depends on an interaction between the endocrinous, nervous and immune systems. The hypothalamic-pituitary-adrenal axis constitutes the paradigm of these interactions with variable secretory responses. Due to this, this cohort study was carried out in order to determine the mean serum cortisol level in critically ill patients at their hospital admission and to analyze the relation between those levels and the patient prognosis. One hundred and twenty two patients that entered the AICU from June 2005 to January 2006 were included and distributed in three groups (G1,G2,G3) according to their serum cortisol level. The mean cortisol level was 55.46 µg/dL.In the group with the lowest cortisol levels (G1), 42.3% of the patients (12/29) died, as well as 33.3% (17/51) of the patients with medium cortisol levels (G2) (RR:1.91, (p=0.5) and 61.90% (26/42) of the patients with the highest levels (G3) (RR:1.78, (p=0.01).Although the mean cortisol level was high, as expected the worse prognoses were associated to low cortisol levels (lower than 20 µg/dL) as well as to those that presented levels higher than 40 µg/dL in whom a significantly higher mortality was observed.

Keywords : Cortisol levels; critical ill patient.

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