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Adelaars S, Konings CJAM, Cox L, Boonen E, Mischi M, Bouwman RA, van de Kerkhof D. The correlation of urea and creatinine concentrations in sweat and saliva with plasma during hemodialysis: an observational cohort study. Clin Chem Lab Med 2024; 62:1118-1125. [PMID: 38253354 DOI: 10.1515/cclm-2023-1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVES Urea and creatinine concentrations in plasma are used to guide hemodialysis (HD) in patients with end-stage renal disease (ESRD). To support individualized HD treatment in a home situation, there is a clinical need for a non-invasive and continuous alternative to plasma for biomarker monitoring during and between cycles of HD. In this observational study, we therefore established the correlation of urea and creatinine concentrations between sweat, saliva and plasma in a cohort of ESRD patients on HD. METHODS Forty HD patients were recruited at the Dialysis Department of the Catharina Hospital Eindhoven. Sweat and salivary urea and creatinine concentrations were analyzed at the start and at the end of one HD cycle and compared to the corresponding plasma concentrations. RESULTS A decrease of urea concentrations during HD was observed in sweat, from 27.86 mmol/L to 12.60 mmol/L, and saliva, from 24.70 mmol/L to 5.64 mmol/L. Urea concentrations in sweat and saliva strongly correlated with the concentrations in plasma (ρ 0.92 [p<0.001] and 0.94 [p<0.001], respectively). Creatinine concentrations also decreased in sweat from 43.39 μmol/L to 19.69 μmol/L, and saliva, from 59.00 μmol/L to 13.70 μmol/L. However, for creatinine, correlation coefficients were lower than for urea for both sweat and saliva compared to plasma (ρ: 0.58 [p<0.001] and 0.77 [p<0.001], respectively). CONCLUSIONS The results illustrate a proof of principle of urea measurements in sweat and saliva to monitor HD adequacy in a non-invasive and continuous manner. Biosensors enabling urea monitoring in sweat or saliva could fill in a clinical need to enable at-home HD for more patients and thereby decrease patient burden.
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Affiliation(s)
- Sophie Adelaars
- Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
- Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Constantijn J A M Konings
- Department Internal Medicine and Kidney Diseases, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Lieke Cox
- Royal Philips, Eindhoven, The Netherlands
| | - Eva Boonen
- Department of Anesthesiology and Intensive Care Medicine, General Hospital Turnhout, Turnhout, Belgium
| | - Massimo Mischi
- Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - R Arthur Bouwman
- Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Daan van de Kerkhof
- Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
- Department of Biomedical Engineering, Chemical Biology, Eindhoven University of Technology, Eindhoven, The Netherlands
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Schaubroeck H, Vandenberghe W, Boer W, Boonen E, Dewulf B, Bourgeois C, Dubois J, Dumoulin A, Fivez T, Gunst J, Hermans G, Lormans P, Meersseman P, Mesotten D, Stessel B, Vanhoof M, De Vlieger G, Hoste E. Acute kidney injury in critical COVID-19: a multicenter cohort analysis in seven large hospitals in Belgium. Crit Care 2022; 26:225. [PMID: 35879765 PMCID: PMC9310674 DOI: 10.1186/s13054-022-04086-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/02/2022] [Indexed: 11/11/2022] Open
Abstract
Background Acute kidney injury (AKI) has been reported as a frequent complication of critical COVID-19. We aimed to evaluate the occurrence of AKI and use of kidney replacement therapy (KRT) in critical COVID-19, to assess patient and kidney outcomes and risk factors for AKI and differences in outcome when the diagnosis of AKI is based on urine output (UO) or on serum creatinine (sCr). Methods Multicenter, retrospective cohort analysis of patients with critical COVID-19 in seven large hospitals in Belgium. AKI was defined according to KDIGO within 21 days after ICU admission. Multivariable logistic regression analysis was used to explore the risk factors for developing AKI and to assess the association between AKI and ICU mortality. Results Of 1286 patients, 85.1% had AKI, and KRT was used in 9.8%. Older age, obesity, a higher APACHE II score and use of mechanical ventilation at day 1 of ICU stay were associated with an increased risk for AKI. After multivariable adjustment, all AKI stages were associated with ICU mortality. AKI was based on sCr in 40.1% and UO in 81.5% of patients. All AKI stages based on sCr and AKI stage 3 based on UO were associated with ICU mortality. Persistent AKI was present in 88.6% and acute kidney disease (AKD) in 87.6%. Rapid reversal of AKI yielded a better prognosis compared to persistent AKI and AKD. Kidney recovery was observed in 47.4% of surviving AKI patients. Conclusions Over 80% of critically ill COVID-19 patients had AKI. This was driven by the high occurrence rate of AKI defined by UO criteria. All AKI stages were associated with mortality (NCT04997915). Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04086-x.
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Peeters B, Güiza F, Boonen E, Meersseman P, Langouche L, Van den Berghe G. Drug-induced HPA axis alterations during acute critical illness: a multivariable association study. Clin Endocrinol (Oxf) 2017; 86:26-36. [PMID: 27422812 DOI: 10.1111/cen.13155] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/30/2016] [Accepted: 07/12/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Critical illness is hallmarked by low plasma ACTH in the face of high plasma cortisol. We hypothesized that frequently used drugs could play a role by affecting the hypothalamic-pituitary-adrenal axis. DESIGN Observational association study. PATIENTS A total of 156 medical-surgical critically ill patients. MEASUREMENTS Plasma concentrations of ACTH and total/free cortisol were quantified upon ICU admission and throughout the first 3 ICU days. The independent associations between drugs administered 24 h prior to ICU admission and plasma ACTH and cortisol concentrations upon ICU admission were quantified with use of multivariable linear regression analyses. RESULTS Upon ICU admission, compared with healthy subjects, patients had low mean±SEM plasma ACTH concentrations (2·7 ± 0·6 pmol/l vs 9·0 ± 1·6 pmol/l, P < 0·0001) in the face of unaltered total plasma cortisol (336·7 ± 30·4 nmol/l vs 300·8 ± 16·6 nmol/l, P = 0·3) and elevated free plasma cortisol concentrations (41·4 ± 5·5 nmol/l vs 5·5 ± 0·8 nmol/l, P = 0·04). Plasma ACTH concentrations remained low (P < 0·001) until day 3, whereas plasma (free) cortisol concentrations steeply increased and remained high (P < 0·001). No independent correlations with plasma ACTH were found. In contrast, the total admission plasma cortisol concentration was independently and negatively associated with the cumulative opioid (P = 0·001) and propofol (P = 0·02) dose, the use of etomidate (P = 0·03), and positively with the cumulative dobutamine dose (P = 0·0007). CONCLUSIONS Besides the known suppressive effect of etomidate, opioids and propofol may also suppress and dobutamine increases plasma cortisol in a dose-dependent manner. The observed independent associations suggest drug effects not mediated centrally via ACTH, but rather peripherally by a direct or indirect action on the adrenal cortex.
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Affiliation(s)
- Bram Peeters
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Fabian Güiza
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Eva Boonen
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Philippe Meersseman
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
- Medical Intensive Care Unit, Department of General Internal Medicine, UZ Leuven, Leuven, Belgium
| | - Lies Langouche
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Greet Van den Berghe
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
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Boonen E, Van den Berghe G. MECHANISMS IN ENDOCRINOLOGY: New concepts to further unravel adrenal insufficiency during critical illness. Eur J Endocrinol 2016; 175:R1-9. [PMID: 26811405 DOI: 10.1530/eje-15-1098] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 01/25/2016] [Indexed: 02/02/2023]
Abstract
The concept of 'relative' adrenal insufficiency during critical illness remains a highly debated disease entity. Several studies have addressed how to diagnose or treat this condition but have often yielded conflicting results, which further fuelled the controversy. The main reason for the controversy is the fact that the pathophysiology is not completely understood. Recently, new insights in the pathophysiology of the hypothalamic-pituitary-adrenal axis response to critical illness were generated. It was revealed that high circulating levels of cortisol during critical illness are explained more by reduced cortisol breakdown than by elevated cortisol production. Cortisol production rate during critical illness is less than doubled during the day but lower than in healthy subjects during the night. High plasma cortisol concentrations due to reduced breakdown in turn reduce plasma ACTH concentrations via feedback inhibition, which with time may lead to an understimulation and hereby a dysfunction of the adrenal cortex. This could explain the high incidence of adrenal insufficiency in the prolonged phase of critical illness. These novel insights have created a new framework for the diagnosis and treatment of adrenal failure during critical illness that has redirected future research.
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Affiliation(s)
- Eva Boonen
- Clinical Division and Laboratory of Intensive Care MedicineDepartment of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Greet Van den Berghe
- Clinical Division and Laboratory of Intensive Care MedicineDepartment of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
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Tambuyzer T, Guiza F, Boonen E, Meersseman P, Vervenne H, Hansen TK, Bjerre M, Van den Berghe G, Berckmans D, Aerts JM, Meyfroidt G. Heart rate time series characteristics for early detection of infections in critically ill patients. J Clin Monit Comput 2016; 31:407-415. [PMID: 27039298 DOI: 10.1007/s10877-016-9870-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/29/2016] [Indexed: 01/21/2023]
Abstract
It is difficult to make a distinction between inflammation and infection. Therefore, new strategies are required to allow accurate detection of infection. Here, we hypothesize that we can distinguish infected from non-infected ICU patients based on dynamic features of serum cytokine concentrations and heart rate time series. Serum cytokine profiles and heart rate time series of 39 patients were available for this study. The serum concentration of ten cytokines were measured using blood sampled every 10 min between 2100 and 0600 hours. Heart rate was recorded every minute. Ten metrics were used to extract features from these time series to obtain an accurate classification of infected patients. The predictive power of the metrics derived from the heart rate time series was investigated using decision tree analysis. Finally, logistic regression methods were used to examine whether classification performance improved with inclusion of features derived from the cytokine time series. The AUC of a decision tree based on two heart rate features was 0.88. The model had good calibration with 0.09 Hosmer-Lemeshow p value. There was no significant additional value of adding static cytokine levels or cytokine time series information to the generated decision tree model. The results suggest that heart rate is a better marker for infection than information captured by cytokine time series when the exact stage of infection is not known. The predictive value of (expensive) biomarkers should always be weighed against the routinely monitored data, and such biomarkers have to demonstrate added value.
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Affiliation(s)
- T Tambuyzer
- Division Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Kasteelpark Arenberg 30, 3001, Louvain, Belgium
| | - F Guiza
- Laboratory of Intensive Care Medicine, Division Cellular and Molecular Medicine, Clinical Department, KU Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - E Boonen
- Laboratory of Intensive Care Medicine, Division Cellular and Molecular Medicine, Clinical Department, KU Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - P Meersseman
- Laboratory of Intensive Care Medicine, Division Cellular and Molecular Medicine, Clinical Department, KU Leuven, Herestraat 49, 3000, Louvain, Belgium.,Medical Intensive Care Unit, Department of Internal Medicine, KU Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - H Vervenne
- Laboratory of Intensive Care Medicine, Division Cellular and Molecular Medicine, Clinical Department, KU Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - T K Hansen
- Immunoendocrine Research Unit, Medical Department M, Aarhus University Hospital, Norrebrogade 44, 8000, Aarhus C, Denmark
| | - M Bjerre
- Immunoendocrine Research Unit, Medical Department M, Aarhus University Hospital, Norrebrogade 44, 8000, Aarhus C, Denmark
| | - G Van den Berghe
- Laboratory of Intensive Care Medicine, Division Cellular and Molecular Medicine, Clinical Department, KU Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - D Berckmans
- Division Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Kasteelpark Arenberg 30, 3001, Louvain, Belgium
| | - J M Aerts
- Division Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Kasteelpark Arenberg 30, 3001, Louvain, Belgium.
| | - G Meyfroidt
- Laboratory of Intensive Care Medicine, Division Cellular and Molecular Medicine, Clinical Department, KU Leuven, Herestraat 49, 3000, Louvain, Belgium
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Gallus M, Ciuraru R, Mothes F, Akylas V, Barmpas F, Beeldens A, Bernard F, Boonen E, Boréave A, Cazaunau M, Charbonnel N, Chen H, Daële V, Dupart Y, Gaimoz C, Grosselin B, Herrmann H, Ifang S, Kurtenbach R, Maille M, Marjanovic I, Michoud V, Mellouki A, Miet K, Moussiopoulos N, Poulain L, Zapf P, George C, Doussin JF, Kleffmann J. Photocatalytic abatement results from a model street canyon. Environ Sci Pollut Res Int 2015; 22:18185-18196. [PMID: 26178827 DOI: 10.1007/s11356-015-4926-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/17/2015] [Indexed: 06/04/2023]
Abstract
During the European Life+ project PhotoPAQ (Demonstration of Photocatalytic remediation Processes on Air Quality), photocatalytic remediation of nitrogen oxides (NOx), ozone (O3), volatile organic compounds (VOCs), and airborne particles on photocatalytic cementitious coating materials was studied in an artificial street canyon setup by comparing with a colocated nonactive reference canyon of the same dimension (5 × 5 × 53 m). Although the photocatalytic material showed reasonably high activity in laboratory studies, no significant reduction of NOx, O3, and VOCs and no impact on particle mass, size distribution, and chemical composition were observed in the field campaign. When comparing nighttime and daytime correlation plots of the two canyons, an average upper limit NOx remediation of ≤2% was derived. This result is consistent only with three recent field studies on photocatalytic NOx remediation in the urban atmosphere, whereas much higher reductions were obtained in most other field investigations. Reasons for the controversial results are discussed, and a more consistent picture of the quantitative remediation is obtained after extrapolation of the results from the various field campaigns to realistic main urban street canyon conditions.
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Affiliation(s)
- M Gallus
- Physikalische und Theoretische Chemie/FB C, Bergische Universität Wuppertal (BUW), Gaußstr. 20, 42119, Wuppertal, Germany
| | - R Ciuraru
- Université de Lyon, Université Lyon 1, CNRS, UMR5256, IRCELYON, Institut de recherches sur la catalyse et l'environnement de Lyon, Villeurbanne, F-69626, France
- University of Bordeaux, EPOC UMR 5805, F-33405, Talence cedex, France
- CNRS, EPOC UMR 5805, F-33405, Talence cedex, France
| | - F Mothes
- Leibniz-Institut für Troposphärenforschung e.V. (TROPOS), Atmospheric Chemistry Department, Permoserstraße 15, 04318, Leipzig, Germany
| | - V Akylas
- Laboratory of Heat Transfer and Environmental Engineering (LHTEE), Aristotle University of Thessaloniki, Box 483, GR 54124, Thessaloniki, Greece
| | - F Barmpas
- Laboratory of Heat Transfer and Environmental Engineering (LHTEE), Aristotle University of Thessaloniki, Box 483, GR 54124, Thessaloniki, Greece
| | - A Beeldens
- Belgian Road Research Centre (BRRC), Woluwedal 42-1200, Brussels, Belgium
| | - F Bernard
- Université de Lyon, Université Lyon 1, CNRS, UMR5256, IRCELYON, Institut de recherches sur la catalyse et l'environnement de Lyon, Villeurbanne, F-69626, France
| | - E Boonen
- Belgian Road Research Centre (BRRC), Woluwedal 42-1200, Brussels, Belgium
| | - A Boréave
- Université de Lyon, Université Lyon 1, CNRS, UMR5256, IRCELYON, Institut de recherches sur la catalyse et l'environnement de Lyon, Villeurbanne, F-69626, France
| | - M Cazaunau
- Institut de Combustion, Aérothermique, Réactivité et Environnement (ICARE), CNRS (UPR 3021)/OSUC, 1C Avenue de la Recherche Scientifique, Orléans, France
| | - N Charbonnel
- Université de Lyon, Université Lyon 1, CNRS, UMR5256, IRCELYON, Institut de recherches sur la catalyse et l'environnement de Lyon, Villeurbanne, F-69626, France
| | - H Chen
- Institut de Combustion, Aérothermique, Réactivité et Environnement (ICARE), CNRS (UPR 3021)/OSUC, 1C Avenue de la Recherche Scientifique, Orléans, France
| | - V Daële
- Institut de Combustion, Aérothermique, Réactivité et Environnement (ICARE), CNRS (UPR 3021)/OSUC, 1C Avenue de la Recherche Scientifique, Orléans, France
| | - Y Dupart
- Université de Lyon, Université Lyon 1, CNRS, UMR5256, IRCELYON, Institut de recherches sur la catalyse et l'environnement de Lyon, Villeurbanne, F-69626, France
| | - C Gaimoz
- LISA, UMR CNRS 7583, Université Paris Est Créteil et Université Paris Diderot, Institut Pierre Simon Laplace, Créteil, France
| | - B Grosselin
- Institut de Combustion, Aérothermique, Réactivité et Environnement (ICARE), CNRS (UPR 3021)/OSUC, 1C Avenue de la Recherche Scientifique, Orléans, France
| | - H Herrmann
- Leibniz-Institut für Troposphärenforschung e.V. (TROPOS), Atmospheric Chemistry Department, Permoserstraße 15, 04318, Leipzig, Germany
| | - S Ifang
- Physikalische und Theoretische Chemie/FB C, Bergische Universität Wuppertal (BUW), Gaußstr. 20, 42119, Wuppertal, Germany
| | - R Kurtenbach
- Physikalische und Theoretische Chemie/FB C, Bergische Universität Wuppertal (BUW), Gaußstr. 20, 42119, Wuppertal, Germany
| | - M Maille
- LISA, UMR CNRS 7583, Université Paris Est Créteil et Université Paris Diderot, Institut Pierre Simon Laplace, Créteil, France
| | - I Marjanovic
- LISA, UMR CNRS 7583, Université Paris Est Créteil et Université Paris Diderot, Institut Pierre Simon Laplace, Créteil, France
| | - V Michoud
- LISA, UMR CNRS 7583, Université Paris Est Créteil et Université Paris Diderot, Institut Pierre Simon Laplace, Créteil, France
| | - A Mellouki
- Institut de Combustion, Aérothermique, Réactivité et Environnement (ICARE), CNRS (UPR 3021)/OSUC, 1C Avenue de la Recherche Scientifique, Orléans, France
| | - K Miet
- LISA, UMR CNRS 7583, Université Paris Est Créteil et Université Paris Diderot, Institut Pierre Simon Laplace, Créteil, France
| | - N Moussiopoulos
- Laboratory of Heat Transfer and Environmental Engineering (LHTEE), Aristotle University of Thessaloniki, Box 483, GR 54124, Thessaloniki, Greece
| | - L Poulain
- Leibniz-Institut für Troposphärenforschung e.V. (TROPOS), Atmospheric Chemistry Department, Permoserstraße 15, 04318, Leipzig, Germany
| | - P Zapf
- LISA, UMR CNRS 7583, Université Paris Est Créteil et Université Paris Diderot, Institut Pierre Simon Laplace, Créteil, France
| | - C George
- Université de Lyon, Université Lyon 1, CNRS, UMR5256, IRCELYON, Institut de recherches sur la catalyse et l'environnement de Lyon, Villeurbanne, F-69626, France
| | - J F Doussin
- LISA, UMR CNRS 7583, Université Paris Est Créteil et Université Paris Diderot, Institut Pierre Simon Laplace, Créteil, France
| | - J Kleffmann
- Physikalische und Theoretische Chemie/FB C, Bergische Universität Wuppertal (BUW), Gaußstr. 20, 42119, Wuppertal, Germany.
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Boonen E, Bornstein SR, Van den Berghe G. New insights into the controversy of adrenal function during critical illness. Lancet Diabetes Endocrinol 2015; 3:805-15. [PMID: 26071883 DOI: 10.1016/s2213-8587(15)00224-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/17/2014] [Accepted: 10/17/2014] [Indexed: 12/18/2022]
Abstract
Critical illness represents a life-threatening disorder necessitating recruitment of defence mechanisms for survival. Herein, the hypothalamic-pituitary-adrenal axis is essential. However, the relevance of a relative insufficiency of the hypothalamic-pituitary-adrenal axis in critical illness, which is diagnosed by a suppressed cortisol response to exogenous adrenocorticotropic hormone (ACTH) irrespective of the plasma cortisol concentration, is controversial. Findings from several studies have provided insights that clarify at least part of this controversy. Rather than an activated hypothalamic-pituitary-adrenal axis, ACTH-independent regulators have been reported to contribute to increased cortisol availability during critical illness. One of these regulators is reduced cortisol breakdown, mediated by suppressed expression and activity of cortisol metabolising enzymes in the liver and kidneys. This downstream mechanism increases concentrations of plasma cortisol, but the ensuing feedback-inhibited ACTH release, when sustained for more than 1 week, has been shown to negatively affect adrenocortical integrity and function. Reduced adrenocortical ACTH signalling could explain reduced cortisol responses to exogenous ACTH. Whether such reduced cortisol responses in the presence of raised plasma (free) cortisol identifies adrenal failure needing treatment is unlikely. Additionally, reduced cortisol breakdown affects the optimum dose of hydrocortisone treatment during critical illness. Identification of patients with an insufficient hypothalamic-pituitary-adrenal axis response and the optimum treatment for this disorder clearly need more well designed preclinical and clinical studies.
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Affiliation(s)
- Eva Boonen
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven University, Leuven, Belgium
| | - Stefan R Bornstein
- Department of Medicine III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany; Diabetes and Nutritional Sciences, Rayne Institute, Denmark Hill Campus, King's College London, London, UK
| | - Greet Van den Berghe
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven University, Leuven, Belgium.
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Meersseman P, Boonen E, Peeters B, Vander Perre S, Wouters PJ, Langouche L, Van den Berghe G. Effect of Early Parenteral Nutrition on the HPA Axis and on Treatment With Corticosteroids in Intensive Care Patients. J Clin Endocrinol Metab 2015; 100:2613-20. [PMID: 25942482 DOI: 10.1210/jc.2015-1846] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nutrition can affect the hypothalamus-pituitary-adrenal axis. We hypothesized that early administration of parenteral nutrition (PN) during critical illness reduces plasma ACTH and cortisol concentrations and thereby increases the use of corticosteroids. METHODS This is a preplanned substudy of a randomized controlled trial (EPaNIC) that compared early PN with late PN in 4640 critically ill patients. We investigated the effect of early vs late PN on any steroid treatment and on treatment for ≥ 5 days to capture patients with clinical suspicion of adrenal insufficiency, and assessed whether this was related to an effect on septic shock. Also, in a propensity score-matched subgroup (n=174) of patients not receiving steroids, plasma ACTH and (free) cortisol were quantified. RESULTS Compared with late PN, more patients on early PN received treatment with corticosteroids (26.2% vs 23.8%; P = .05) and with corticosteroids for ≥ 5 days (14.0% vs 11.9%; P = .03). However, plasma ACTH and (free) cortisol concentrations were unaffected and thus could not explain the higher use of corticosteroids with early PN. Instead, more patients developed new septic shock with early PN (17.0%) than with late PN (14.2%) (P = .01). In multivariate logistic regression analysis, new septic shock was an independent determinant for ≥ 5 days steroid treatment (odds ratio, 6.25; 95% confidence interval, 4.93-7.94; P < .0001), statistically explaining the effect of early PN on steroid treatment. CONCLUSIONS Early PN did not affect plasma concentrations of ACTH and (free) cortisol, but increased the incidence of septic shock, which statistically explained why more patients on early PN received corticosteroids.
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Affiliation(s)
- Philippe Meersseman
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine (P.M., E.B., B.P., S.V.P., P.J.W., L.L., G.V.d.B.), KU Leuven, 3000 Leuven, Belgium; Medical Intensive Care Unit, Department of General Internal Medicine (P.M.), University Hospital Leuven, 3000 Leuven, Belgium; and Department of Intensive Care Medicine (E.B., B.P., P.J.W., L.L., G.V.d.B.), University Hospital Leuven, 3000 Leuven, Belgium
| | - Eva Boonen
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine (P.M., E.B., B.P., S.V.P., P.J.W., L.L., G.V.d.B.), KU Leuven, 3000 Leuven, Belgium; Medical Intensive Care Unit, Department of General Internal Medicine (P.M.), University Hospital Leuven, 3000 Leuven, Belgium; and Department of Intensive Care Medicine (E.B., B.P., P.J.W., L.L., G.V.d.B.), University Hospital Leuven, 3000 Leuven, Belgium
| | - Bram Peeters
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine (P.M., E.B., B.P., S.V.P., P.J.W., L.L., G.V.d.B.), KU Leuven, 3000 Leuven, Belgium; Medical Intensive Care Unit, Department of General Internal Medicine (P.M.), University Hospital Leuven, 3000 Leuven, Belgium; and Department of Intensive Care Medicine (E.B., B.P., P.J.W., L.L., G.V.d.B.), University Hospital Leuven, 3000 Leuven, Belgium
| | - Sarah Vander Perre
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine (P.M., E.B., B.P., S.V.P., P.J.W., L.L., G.V.d.B.), KU Leuven, 3000 Leuven, Belgium; Medical Intensive Care Unit, Department of General Internal Medicine (P.M.), University Hospital Leuven, 3000 Leuven, Belgium; and Department of Intensive Care Medicine (E.B., B.P., P.J.W., L.L., G.V.d.B.), University Hospital Leuven, 3000 Leuven, Belgium
| | - Pieter J Wouters
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine (P.M., E.B., B.P., S.V.P., P.J.W., L.L., G.V.d.B.), KU Leuven, 3000 Leuven, Belgium; Medical Intensive Care Unit, Department of General Internal Medicine (P.M.), University Hospital Leuven, 3000 Leuven, Belgium; and Department of Intensive Care Medicine (E.B., B.P., P.J.W., L.L., G.V.d.B.), University Hospital Leuven, 3000 Leuven, Belgium
| | - Lies Langouche
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine (P.M., E.B., B.P., S.V.P., P.J.W., L.L., G.V.d.B.), KU Leuven, 3000 Leuven, Belgium; Medical Intensive Care Unit, Department of General Internal Medicine (P.M.), University Hospital Leuven, 3000 Leuven, Belgium; and Department of Intensive Care Medicine (E.B., B.P., P.J.W., L.L., G.V.d.B.), University Hospital Leuven, 3000 Leuven, Belgium
| | - Greet Van den Berghe
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine (P.M., E.B., B.P., S.V.P., P.J.W., L.L., G.V.d.B.), KU Leuven, 3000 Leuven, Belgium; Medical Intensive Care Unit, Department of General Internal Medicine (P.M.), University Hospital Leuven, 3000 Leuven, Belgium; and Department of Intensive Care Medicine (E.B., B.P., P.J.W., L.L., G.V.d.B.), University Hospital Leuven, 3000 Leuven, Belgium
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Peeters B, Boonen E, Langouche L, Van den Berghe G. The HPA axis response to critical illness: New study results with diagnostic and therapeutic implications. Mol Cell Endocrinol 2015; 408:235-40. [PMID: 25462585 DOI: 10.1016/j.mce.2014.11.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 11/18/2014] [Accepted: 11/19/2014] [Indexed: 10/24/2022]
Abstract
For decades, elevated plasma cortisol concentrations in critically ill patients were exclusively ascribed to a stimulated hypothalamus-pituitary-adrenal axis with increased circulating adrenocorticotropic hormone (ACTH) inferred to several-fold increase adrenal cortisol synthesis. However, 'ACTH-cortisol dissociation' has been reported during critical illness, referring to low circulating ACTH coinciding with elevated circulating cortisol. It was recently shown that metabolism of cortisol is significantly reduced in critically ill patients explained by a suppression of the activity and expression of cortisol metabolizing enzymes in kidney and liver. This reduced cortisol breakdown determines hypercortisolemia, much more than increased cortisol production, in the critically ill. Although the low plasma ACTH concentrations, evoked by the elevated plasma cortisol via feedback inhibition, are part of this adaptation, they may negatively affect adrenocortical structure and function in the prolonged phase of critical illness. These new insights have implications for diagnosis and treatment of adrenal insufficiency in critically ill patients.
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Affiliation(s)
- B Peeters
- Clinical Division and Laboratory of Intensive Care Medicine, Department Cellular and Molecular Medicine, KU Leuven University, Leuven B-3000, Belgium
| | - E Boonen
- Clinical Division and Laboratory of Intensive Care Medicine, Department Cellular and Molecular Medicine, KU Leuven University, Leuven B-3000, Belgium
| | - L Langouche
- Clinical Division and Laboratory of Intensive Care Medicine, Department Cellular and Molecular Medicine, KU Leuven University, Leuven B-3000, Belgium
| | - G Van den Berghe
- Clinical Division and Laboratory of Intensive Care Medicine, Department Cellular and Molecular Medicine, KU Leuven University, Leuven B-3000, Belgium.
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10
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Boonen E, Akylas V, Barmpas F, Boréave A, Bottalico L, Cazaunau M, Chen H, Daële V, De Marco T, Doussin JF, Gaimoz C, Gallus M, George C, Grand N, Grosselin B, Guerrini GL, Herrmann H, Ifang S, Kleffmann J, Kurtenbach R, Maille M, Manganelli G, Mellouki A, Miet K, Mothes F, Moussiopoulos N, Poulain L, Rabe R, Zapf P, Beeldens A. Construction of a photocatalytic de-polluting field site in the Leopold II tunnel in Brussels. J Environ Manage 2015; 155:136-144. [PMID: 25863437 DOI: 10.1016/j.jenvman.2015.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/27/2015] [Accepted: 03/02/2015] [Indexed: 06/04/2023]
Abstract
Within the framework of the European Life+-funded project PhotoPAQ (Demonstration of Photocatalytic remediation Processes on Air Quality), which was aimed at demonstrating the effectiveness of photocatalytic coating materials on a realistic scale, a photocatalytic de-polluting field site was set up in the Leopold II tunnel in Brussels, Belgium. For that purpose, photocatalytic cementitious materials were applied on the side walls and ceiling of selected test sections inside a one-way tunnel tube. This article presents the configuration of the test sections used and the preparation and implementation of the measuring campaigns inside the Leopold II tunnel. While emphasizing on how to implement measuring campaigns under such conditions, difficulties encountered during these extensive field campaigns are presented and discussed. This included the severe de-activation observed for the investigated material under the polluted tunnel conditions, which was revealed by additional laboratory experiments on photocatalytic samples that were exposed to tunnel air. Finally, recommendations for future applications of photocatalytic building materials inside tunnels are given.
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Affiliation(s)
- E Boonen
- Belgian Road Research Centre (BRRC), Woluwedal 42, 1200 Brussels, Belgium.
| | - V Akylas
- Laboratory of Heat Transfer and Environmental Engineering (LHTEE), Aristotle University of Thessaloniki, Box 483, GR 54124 Thessaloniki, Greece
| | - F Barmpas
- Laboratory of Heat Transfer and Environmental Engineering (LHTEE), Aristotle University of Thessaloniki, Box 483, GR 54124 Thessaloniki, Greece
| | - A Boréave
- Université Lyon 1, CNRS, UMR5256, IRCELYON, Institut de Recherches sur la Catalyse et l'Environnement de Lyon, Villeurbanne, Lyon F 6962, France
| | - L Bottalico
- CTG Italcementi Group, Via Stezzano 87, 24126 Bergamo, Italy
| | - M Cazaunau
- Institut de Combustion, Aérothermique, Réactivité et Environnement (ICARE), CNRS (UPR 3021)/OSUC, 1C Avenue de la Recherche Scientifique, Orléans, France
| | - H Chen
- Institut de Combustion, Aérothermique, Réactivité et Environnement (ICARE), CNRS (UPR 3021)/OSUC, 1C Avenue de la Recherche Scientifique, Orléans, France
| | - V Daële
- Institut de Combustion, Aérothermique, Réactivité et Environnement (ICARE), CNRS (UPR 3021)/OSUC, 1C Avenue de la Recherche Scientifique, Orléans, France
| | - T De Marco
- CTG Italcementi Group, Via Stezzano 87, 24126 Bergamo, Italy
| | - J F Doussin
- LISA, UMR CNRS 7583, Université Paris Est Créteil et Université Paris Diderot, Institut Pierre Simon Laplace, Créteil, France
| | - C Gaimoz
- LISA, UMR CNRS 7583, Université Paris Est Créteil et Université Paris Diderot, Institut Pierre Simon Laplace, Créteil, France
| | - M Gallus
- Physikalische Chemie /FB C, Bergische Universität Wuppertal (BUW), Gaußstr. 20, 42119 Wuppertal, Germany
| | - C George
- Université Lyon 1, CNRS, UMR5256, IRCELYON, Institut de Recherches sur la Catalyse et l'Environnement de Lyon, Villeurbanne, Lyon F 6962, France
| | - N Grand
- LISA, UMR CNRS 7583, Université Paris Est Créteil et Université Paris Diderot, Institut Pierre Simon Laplace, Créteil, France
| | - B Grosselin
- Institut de Combustion, Aérothermique, Réactivité et Environnement (ICARE), CNRS (UPR 3021)/OSUC, 1C Avenue de la Recherche Scientifique, Orléans, France
| | - G L Guerrini
- Italcementi Group, Via Stezzano 87, 24126 Bergamo, Italy
| | - H Herrmann
- Leibniz-Institut für Troposphärenforschung e.V. (TROPOS), Atmospheric Chemistry Dept., Permoserstraße 15, 04318 Leipzig, Germany
| | - S Ifang
- Physikalische Chemie /FB C, Bergische Universität Wuppertal (BUW), Gaußstr. 20, 42119 Wuppertal, Germany
| | - J Kleffmann
- Physikalische Chemie /FB C, Bergische Universität Wuppertal (BUW), Gaußstr. 20, 42119 Wuppertal, Germany
| | - R Kurtenbach
- Physikalische Chemie /FB C, Bergische Universität Wuppertal (BUW), Gaußstr. 20, 42119 Wuppertal, Germany
| | - M Maille
- LISA, UMR CNRS 7583, Université Paris Est Créteil et Université Paris Diderot, Institut Pierre Simon Laplace, Créteil, France
| | - G Manganelli
- CTG Italcementi Group, Via Stezzano 87, 24126 Bergamo, Italy
| | - A Mellouki
- Institut de Combustion, Aérothermique, Réactivité et Environnement (ICARE), CNRS (UPR 3021)/OSUC, 1C Avenue de la Recherche Scientifique, Orléans, France
| | - K Miet
- LISA, UMR CNRS 7583, Université Paris Est Créteil et Université Paris Diderot, Institut Pierre Simon Laplace, Créteil, France
| | - F Mothes
- Leibniz-Institut für Troposphärenforschung e.V. (TROPOS), Atmospheric Chemistry Dept., Permoserstraße 15, 04318 Leipzig, Germany
| | - N Moussiopoulos
- Laboratory of Heat Transfer and Environmental Engineering (LHTEE), Aristotle University of Thessaloniki, Box 483, GR 54124 Thessaloniki, Greece
| | - L Poulain
- Leibniz-Institut für Troposphärenforschung e.V. (TROPOS), Atmospheric Chemistry Dept., Permoserstraße 15, 04318 Leipzig, Germany
| | - R Rabe
- Leibniz-Institut für Troposphärenforschung e.V. (TROPOS), Atmospheric Chemistry Dept., Permoserstraße 15, 04318 Leipzig, Germany
| | - P Zapf
- LISA, UMR CNRS 7583, Université Paris Est Créteil et Université Paris Diderot, Institut Pierre Simon Laplace, Créteil, France
| | - A Beeldens
- Belgian Road Research Centre (BRRC), Woluwedal 42, 1200 Brussels, Belgium
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Boonen E, Van den Berghe G. Understanding the HPA response to critical illness: novel insights with clinical implications. Intensive Care Med 2014; 41:131-3. [PMID: 25406407 DOI: 10.1007/s00134-014-3545-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 11/01/2014] [Indexed: 01/31/2023]
Affiliation(s)
- Eva Boonen
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven University, Herestraat 49, 3000, Leuven, Belgium
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Boonen E, Langouche L, Janssens T, Meersseman P, Vervenne H, De Samblanx E, Pironet Z, Van Dyck L, Vander Perre S, Derese I, Van den Berghe G. Impact of duration of critical illness on the adrenal glands of human intensive care patients. J Clin Endocrinol Metab 2014; 99:4214-22. [PMID: 25062464 DOI: 10.1210/jc.2014-2429] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Adrenal insufficiency is considered to be prevalent during critical illness, although the pathophysiology, diagnostic criteria, and optimal therapeutic strategy remain controversial. During critical illness, reduced cortisol breakdown contributes substantially to elevated plasma cortisol and low plasma ACTH concentrations. OBJECTIVE Because ACTH has a trophic impact on the adrenal cortex, we hypothesized that with a longer duration of critical illness, subnormal ACTH adrenocortical stimulation predisposes to adrenal insufficiency. DESIGN, SETTING AND PARTICIPANTS Adrenal glands were harvested 24 hours or sooner after death from 13 long intensive care unit (ICU)-stay patients, 27 short ICU-stay patients, and 13 controls. Prior glucocorticoid treatment was excluded. MAIN OUTCOME AND MEASURE(S): Microscopic adrenocortical zonational structure was evaluated by hematoxylin and eosin staining. The amount of adrenal cholesterol esters was determined by Oil-Red-O staining, and mRNA expression of ACTH-regulated steroidogenic enzymes was quantified. RESULTS The adrenocortical zonational structure was disturbed in patients as compared with controls (P < .0001), with indistinguishable adrenocortical zones present only in long ICU-stay patients (P = .003 vs. controls). Adrenal glands from long ICU-stay patients, but not those of short ICU-stay patients, contained 21% less protein (P = .03) and 9% more fluid (P = .01) than those from controls, whereas they tended to weigh less for comparable adrenal surface area. There was 78% less Oil-Red-O staining in long ICU-stay patients than in controls and in short-stay patients (P = .03), the latter similar to controls (P = .31). The mRNA expression of melanocortin 2 receptor, scavenger-receptor class B, member 1, 3-hydroxy-3-methylglutaryl-CoA reductase, steroidogenic acute regulatory protein, and cytochrome P450 cholesterol side-chain cleavage enzyme was at least 58% lower in long ICU-stay patients than in controls (all P ≤ .03) and of melanocortin 2 receptor, scavenger-receptor class B, member 1, steroidogenic acute regulatory protein, and cytochrome P450 cholesterol side-chain cleavage enzyme at least 53% lower than in short ICU-stay patients (all P ≤ .04), whereas gene expression in short ICU-stay patients was similar to controls. CONCLUSION AND RELEVANCE Lipid depletion and reduced ACTH-regulated gene expression in prolonged critical illness suggest that sustained lack of ACTH may contribute to the risk of adrenal insufficiency in long-stay ICU patients.
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Affiliation(s)
- Eva Boonen
- Clinical Division and Laboratory of Intensive Care Medicine (E.B., L.L., T.J., H.V., E.D.S., Z.P., L.V.D., S.V.P.I.D., G.V.d.B.), Department Cellular and Molecular Medicine, and Clinical Department of Internal Medicine (P.M.), University of Leuven (KU Leuven), B-3000 Leuven, Belgium
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Abstract
PURPOSE OF REVIEW Critical illness is uniformly characterized by elevated plasma cortisol concentrations, traditionally attributed exclusively to increased cortisol production driven by an activated hypothalamic pituitary adrenal axis. However, as plasma adrenocorticotropic hormone (ACTH) concentrations are often not elevated or even low during critical illness, alternative mechanisms must contribute. RECENT FINDINGS Recent investigations revealed that plasma clearance of cortisol is markedly reduced during critical illness, explained by suppressed expression and activity of the main cortisol metabolizing enzymes in liver and kidney. Furthermore, unlike previously inferred, cortisol production rate in critically ill patients was only moderately increased to less than double that of matched healthy subjects. In the face of low-plasma ACTH concentrations, these data suggest that other factors drive hypercortisolism during critical illness, which may suppress ACTH by feedback inhibition. These new insights add to the limitations of the current diagnostic tools to identify patients at risk of failing adrenal function during critical illness. They also urge to investigate the impact of lower hydrocortisone doses than those hitherto used. SUMMARY Recent novel insights reshape the current understanding of the hormonal stress response to critical illness and further underline the need for more studies to unravel the pathophysiology of adrenal (dys)functioning during critical illness.
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Affiliation(s)
- Eva Boonen
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
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Abstract
CONTEXT Critical illness, an extreme form of severe physical stress, is characterized by important endocrine and metabolic changes. Due to critical care medicine, survival from previously lethal conditions has become possible, but many patients now enter a chronic phase of critical illness. The role of the endocrine and metabolic responses to acute and prolonged critical illness in mediating or hampering recovery remains highly debated. EVIDENCE ACQUISITION The recent literature on changes within the hypothalamic-pituitary-thyroid axis and the hypothalamic-pituitary-adrenal axis and on hyperglycemia in relation to recovery from critical illness was critically appraised and interpreted against previous insights. Possible therapeutic implications of the novel insights were analyzed. Specific remaining questions were formulated. EVIDENCE SYNTHESIS In recent years, important novel insights in the pathophysiology and the consequences of some of these endocrine responses to acute and chronic critical illness were generated. Acute endocrine adaptations are directed toward providing energy and substrates for the vital fight-or-flight response in a context of exogenous substrate deprivation. Distinct endocrine and metabolic alterations characterize the chronic phase of critical illness, which seems to be no longer solely beneficial and could hamper recovery and rehabilitation. CONCLUSIONS Important novel insights reshape the current view on endocrine and metabolic responses to critical illness and further clarify underlying pathways. Although many issues remain unresolved, some therapeutic implications were already identified. More work is required to find better treatments, and the optimal timing for such treatments, to further prevent protracted critical illness, to enhance recovery thereof, and to optimize rehabilitation.
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Affiliation(s)
- Eva Boonen
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, B-3000 Leuven, Belgium
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15
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Boonen E, Meersseman P, Vervenne H, Meyfroidt G, Guïza F, Wouters PJ, Veldhuis JD, Van den Berghe G. Reduced nocturnal ACTH-driven cortisol secretion during critical illness. Am J Physiol Endocrinol Metab 2014; 306:E883-92. [PMID: 24569590 PMCID: PMC3989736 DOI: 10.1152/ajpendo.00009.2014] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recently, during critical illness, cortisol metabolism was found to be reduced. We hypothesize that such reduced cortisol breakdown may suppress pulsatile ACTH and cortisol secretion via feedback inhibition. To test this hypothesis, nocturnal ACTH and cortisol secretory profiles were constructed by deconvolution analysis from plasma concentration time series in 40 matched critically ill patients and eight healthy controls, excluding diseases or drugs that affect the hypothalamic-pituitary-adrenal axis. Blood was sampled every 10 min between 2100 and 0600 to quantify plasma concentrations of ACTH and (free) cortisol. Approximate entropy, an estimation of process irregularity, cross-approximate entropy, a measure of ACTH-cortisol asynchrony, and ACTH-cortisol dose-response relationships were calculated. Total and free plasma cortisol concentrations were higher at all times in patients than in controls (all P < 0.04). Pulsatile cortisol secretion was 54% lower in patients than in controls (P = 0.005), explained by reduced cortisol burst mass (P = 0.03), whereas cortisol pulse frequency (P = 0.35) and nonpulsatile cortisol secretion (P = 0.80) were unaltered. Pulsatile ACTH secretion was 31% lower in patients than in controls (P = 0.03), again explained by a lower ACTH burst mass (P = 0.02), whereas ACTH pulse frequency (P = 0.50) and nonpulsatile ACTH secretion (P = 0.80) were unchanged. ACTH-cortisol dose response estimates were similar in patients and controls. ACTH and cortisol approximate entropy were higher in patients (P ≤ 0.03), as was ACTH-cortisol cross-approximate entropy (P ≤ 0.001). We conclude that hypercortisolism during critical illness coincided with suppressed pulsatile ACTH and cortisol secretion and a normal ACTH-cortisol dose response. Increased irregularity and asynchrony of the ACTH and cortisol time series supported non-ACTH-dependent mechanisms driving hypercortisolism during critical illness.
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Affiliation(s)
- Eva Boonen
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, and
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16
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Boonen E, Vervenne H, Meersseman P, Andrew R, Mortier L, Declercq PE, Vanwijngaerden YM, Spriet I, Wouters PJ, Vander Perre S, Langouche L, Vanhorebeek I, Walker BR, Van den Berghe G. Reduced cortisol metabolism during critical illness. N Engl J Med 2013; 368:1477-88. [PMID: 23506003 PMCID: PMC4413428 DOI: 10.1056/nejmoa1214969] [Citation(s) in RCA: 293] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Critical illness is often accompanied by hypercortisolemia, which has been attributed to stress-induced activation of the hypothalamic-pituitary-adrenal axis. However, low corticotropin levels have also been reported in critically ill patients, which may be due to reduced cortisol metabolism. METHODS In a total of 158 patients in the intensive care unit and 64 matched controls, we tested five aspects of cortisol metabolism: daily levels of corticotropin and cortisol; plasma cortisol clearance, metabolism, and production during infusion of deuterium-labeled steroid hormones as tracers; plasma clearance of 100 mg of hydrocortisone; levels of urinary cortisol metabolites; and levels of messenger RNA and protein in liver and adipose tissue, to assess major cortisol-metabolizing enzymes. RESULTS Total and free circulating cortisol levels were consistently higher in the patients than in controls, whereas corticotropin levels were lower (P<0.001 for both comparisons). Cortisol production was 83% higher in the patients (P=0.02). There was a reduction of more than 50% in cortisol clearance during tracer infusion and after the administration of 100 mg of hydrocortisone in the patients (P≤0.03 for both comparisons). All these factors accounted for an increase by a factor of 3.5 in plasma cortisol levels in the patients, as compared with controls (P<0.001). Impaired cortisol clearance also correlated with a lower cortisol response to corticotropin stimulation. Reduced cortisol metabolism was associated with reduced inactivation of cortisol in the liver and kidney, as suggested by urinary steroid ratios, tracer kinetics, and assessment of liver-biopsy samples (P≤0.004 for all comparisons). CONCLUSIONS During critical illness, reduced cortisol breakdown, related to suppressed expression and activity of cortisol-metabolizing enzymes, contributed to hypercortisolemia and hence corticotropin suppression. The diagnostic and therapeutic implications for critically ill patients are unknown. (Funded by the Belgian Fund for Scientific Research and others; ClinicalTrials.gov numbers, NCT00512122 and NCT00115479; and Current Controlled Trials numbers, ISRCTN49433936, ISRCTN49306926, and ISRCTN08083905.).
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Affiliation(s)
- Eva Boonen
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
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Boonen E, Vervenne H, Meersseman P, Mortier L, Vanwijngaerden YM, Spriet I, Langouche L, Vanhorebeek I, Van den Berghe G. Reduced cortisol metabolism drives hypercortisolism in critical illness. Crit Care 2012. [PMCID: PMC3363573 DOI: 10.1186/cc10762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Fagot M, De Cauwer B, Reheul D, Bulcke R, Boonen E, Beeldens A. Weed inhibitory effect of different paving constructions. Commun Agric Appl Biol Sci 2011; 76:521-523. [PMID: 22696960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- M Fagot
- Ghent University, Faculty of Bioscience Engineering, Dept. of Plant Production, Coupure Links 653, 9000 Gent, Belgium.
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