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Tarjányi Z, Montskó G, Kenyeres P, Márton Z, Hágendorn R, Gulyás E, Nemes O, Bajnok L, L Kovács G, Mezősi E. Free and total cortisol levels are useful prognostic markers in critically ill patients: a prospective observational study. Eur J Endocrinol 2014; 171:751-9. [PMID: 25271243 DOI: 10.1530/eje-14-0576] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The role of cortisol in the prediction of mortality risk in critical illness is controversial in the literature. The aim of this study was to evaluate the prognostic value of cortisol concentrations in a mixed population of critically ill patients in medical emergencies. DESIGN In this prospective, observational study, measurement of total (TC) and free cortisol (FC) levels was made in the serum samples of 69 critically ill patients (39 males and 30 females, median age of 74 years) at admission (0 h) and 6, 24, 48, and 96 h after admission. METHODS Cortisol levels were determined using HPLC coupled high-resolution ESI-TOF mass spectrometry. The severity of disease was calculated by prognostic scores. Statistical analyses were performed using the SPSS 22.0 software. RESULTS The range of TC varied between 49.9 and 8797.8 nmol/l, FC between 0.4 and 759.9 nmol/l. The levels of FC at 0, 6, 24, and 48 h and TC at 0, 6 h were significantly elevated in non-survivors and correlated with the predicted mortality. The prognostic value of these cortisol levels was comparable with the routinely used mortality scores. In predictive models, FC at 6, 24, and 48 h proved to be an independent determinant of mortality. CONCLUSIONS The predictive values of FC in the first 2 days after admission and TC within 6 h are comparable with the complex, routinely used mortality scores in evaluating the prognosis of critically ill patients. The cortisol response probably reflects the severity of disease.
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Affiliation(s)
- Zita Tarjányi
- First Department of Internal MedicineFaculty of Medicine, University of Pécs, 13 Ifjúság, Pécs H-7624, HungaryDepartment of Laboratory MedicineFaculty of MedicineSzentágothai Research CentreUniversity of Pécs, Pécs, Hungary First Department of Internal MedicineFaculty of Medicine, University of Pécs, 13 Ifjúság, Pécs H-7624, HungaryDepartment of Laboratory MedicineFaculty of MedicineSzentágothai Research CentreUniversity of Pécs, Pécs, Hungary
| | - Gergely Montskó
- First Department of Internal MedicineFaculty of Medicine, University of Pécs, 13 Ifjúság, Pécs H-7624, HungaryDepartment of Laboratory MedicineFaculty of MedicineSzentágothai Research CentreUniversity of Pécs, Pécs, Hungary First Department of Internal MedicineFaculty of Medicine, University of Pécs, 13 Ifjúság, Pécs H-7624, HungaryDepartment of Laboratory MedicineFaculty of MedicineSzentágothai Research CentreUniversity of Pécs, Pécs, Hungary
| | - Péter Kenyeres
- First Department of Internal MedicineFaculty of Medicine, University of Pécs, 13 Ifjúság, Pécs H-7624, HungaryDepartment of Laboratory MedicineFaculty of MedicineSzentágothai Research CentreUniversity of Pécs, Pécs, Hungary
| | - Zsolt Márton
- First Department of Internal MedicineFaculty of Medicine, University of Pécs, 13 Ifjúság, Pécs H-7624, HungaryDepartment of Laboratory MedicineFaculty of MedicineSzentágothai Research CentreUniversity of Pécs, Pécs, Hungary
| | - Roland Hágendorn
- First Department of Internal MedicineFaculty of Medicine, University of Pécs, 13 Ifjúság, Pécs H-7624, HungaryDepartment of Laboratory MedicineFaculty of MedicineSzentágothai Research CentreUniversity of Pécs, Pécs, Hungary
| | - Erna Gulyás
- First Department of Internal MedicineFaculty of Medicine, University of Pécs, 13 Ifjúság, Pécs H-7624, HungaryDepartment of Laboratory MedicineFaculty of MedicineSzentágothai Research CentreUniversity of Pécs, Pécs, Hungary
| | - Orsolya Nemes
- First Department of Internal MedicineFaculty of Medicine, University of Pécs, 13 Ifjúság, Pécs H-7624, HungaryDepartment of Laboratory MedicineFaculty of MedicineSzentágothai Research CentreUniversity of Pécs, Pécs, Hungary
| | - László Bajnok
- First Department of Internal MedicineFaculty of Medicine, University of Pécs, 13 Ifjúság, Pécs H-7624, HungaryDepartment of Laboratory MedicineFaculty of MedicineSzentágothai Research CentreUniversity of Pécs, Pécs, Hungary
| | - Gábor L Kovács
- First Department of Internal MedicineFaculty of Medicine, University of Pécs, 13 Ifjúság, Pécs H-7624, HungaryDepartment of Laboratory MedicineFaculty of MedicineSzentágothai Research CentreUniversity of Pécs, Pécs, Hungary First Department of Internal MedicineFaculty of Medicine, University of Pécs, 13 Ifjúság, Pécs H-7624, HungaryDepartment of Laboratory MedicineFaculty of MedicineSzentágothai Research CentreUniversity of Pécs, Pécs, Hungary
| | - Emese Mezősi
- First Department of Internal MedicineFaculty of Medicine, University of Pécs, 13 Ifjúság, Pécs H-7624, HungaryDepartment of Laboratory MedicineFaculty of MedicineSzentágothai Research CentreUniversity of Pécs, Pécs, Hungary
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