Adrenal response in patients with septic shock of abdominal origin : relationship to survival
To evaluate the prognostic value of adrenocortical response to corticotropin in septic shock patients operated on exclusively for an intra-abdominal source of infection. Prospective, observational, single-center study in a surgical intensive care unit of a university hospital 118 consecutive septic...
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| Veröffentlicht in: | Intensive care medicine 2007-10, Vol.33 (10), p.1761-1766 |
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| creator | RICHE, Florence C BOUTRON, Carole M CHOLLEY, Bernard P VALLEUR, Patrice BERTON, Christine LAISNE, Marie-Josèphe LAUNAY, Jean-Marie CHAPPUIS, Philippe PEYNET, Jacqueline VICAUT, Eric PAYEN, Didier |
| description | To evaluate the prognostic value of adrenocortical response to corticotropin in septic shock patients operated on exclusively for an intra-abdominal source of infection.
Prospective, observational, single-center study in a surgical intensive care unit of a university hospital
118 consecutive septic shock patients undergoing laparotomy or drainage for intra-abdominal infection.
Baseline cortisol (t (0)) and cortisol response to corticotropin test (Delta) were measured during the first 24 h following onset of shock. The relationship between adrenal function test results and survival was analyzed as well as the effect of etomidate anesthesia. Cortisol plasma level at t (0) was higher in nonsurvivors than in survivors (33 +/- 23 vs. 25 +/- 14 microg/dl), but the response to corticotropin test did not differ between these two subgroups. ROC analysis showed threshold values for t (0) (32 microg/dl) and Delta (8 microg/dl) that best discriminated survivors from nonsurvivors in our population. We observed no difference in survival at the end of hospital stay using log rank test when patients were separated according to t (0), Delta, or both. In addition, adrenal function tests and survival did not differ in patients who received etomidate anesthesia (n = 69) during the surgical treatment of their abdominal sepsis.
In this cohort of patients with abdominal septic shock baseline cortisol level and the response to corticotropin test did not discriminate survivors from nonsurvivors. No deleterious impact of etomidate anesthesia on adrenal function tests and survival was observed in these patients. |
| doi_str_mv | 10.1007/s00134-007-0770-4 |
| format | Article |
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Prospective, observational, single-center study in a surgical intensive care unit of a university hospital
118 consecutive septic shock patients undergoing laparotomy or drainage for intra-abdominal infection.
Baseline cortisol (t (0)) and cortisol response to corticotropin test (Delta) were measured during the first 24 h following onset of shock. The relationship between adrenal function test results and survival was analyzed as well as the effect of etomidate anesthesia. Cortisol plasma level at t (0) was higher in nonsurvivors than in survivors (33 +/- 23 vs. 25 +/- 14 microg/dl), but the response to corticotropin test did not differ between these two subgroups. ROC analysis showed threshold values for t (0) (32 microg/dl) and Delta (8 microg/dl) that best discriminated survivors from nonsurvivors in our population. We observed no difference in survival at the end of hospital stay using log rank test when patients were separated according to t (0), Delta, or both. In addition, adrenal function tests and survival did not differ in patients who received etomidate anesthesia (n = 69) during the surgical treatment of their abdominal sepsis.
In this cohort of patients with abdominal septic shock baseline cortisol level and the response to corticotropin test did not discriminate survivors from nonsurvivors. No deleterious impact of etomidate anesthesia on adrenal function tests and survival was observed in these patients.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-007-0770-4</identifier><identifier>PMID: 17618417</identifier><identifier>CODEN: ICMED9</identifier><language>eng</language><publisher>Heidelberg: Springer</publisher><subject>Abdomen ; Adrenal Glands - physiopathology ; Adrenocorticotropic Hormone ; Aged ; Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anesthetics, Intravenous ; Biological and medical sciences ; Blood ; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care ; Emergency and intensive care: infection, septic shock ; Etomidate ; Female ; Hormones ; Hospitals ; Hospitals, University ; Humans ; Hydrocortisone - blood ; Infections ; Intensive care ; Intensive care medicine ; Intensive Care Units ; Intubation ; Laparotomy ; Male ; Medical sciences ; Predictive Value of Tests ; Prospective Studies ; Sepsis ; Shock, Septic - mortality ; Shock, Septic - physiopathology ; Shock, Septic - surgery ; Survival analysis ; Survival Rate</subject><ispartof>Intensive care medicine, 2007-10, Vol.33 (10), p.1761-1766</ispartof><rights>2007 INIST-CNRS</rights><rights>Springer-Verlag 2007</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-fb93f5c06ed94a1708f4837f17f4b6853d40408f5c3f4141d2b76256ff114ba83</citedby><cites>FETCH-LOGICAL-c356t-fb93f5c06ed94a1708f4837f17f4b6853d40408f5c3f4141d2b76256ff114ba83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19135226$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17618417$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>RICHE, Florence C</creatorcontrib><creatorcontrib>BOUTRON, Carole M</creatorcontrib><creatorcontrib>CHOLLEY, Bernard P</creatorcontrib><creatorcontrib>VALLEUR, Patrice</creatorcontrib><creatorcontrib>BERTON, Christine</creatorcontrib><creatorcontrib>LAISNE, Marie-Josèphe</creatorcontrib><creatorcontrib>LAUNAY, Jean-Marie</creatorcontrib><creatorcontrib>CHAPPUIS, Philippe</creatorcontrib><creatorcontrib>PEYNET, Jacqueline</creatorcontrib><creatorcontrib>VICAUT, Eric</creatorcontrib><creatorcontrib>PAYEN, Didier</creatorcontrib><title>Adrenal response in patients with septic shock of abdominal origin : relationship to survival</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><description>To evaluate the prognostic value of adrenocortical response to corticotropin in septic shock patients operated on exclusively for an intra-abdominal source of infection.
Prospective, observational, single-center study in a surgical intensive care unit of a university hospital
118 consecutive septic shock patients undergoing laparotomy or drainage for intra-abdominal infection.
Baseline cortisol (t (0)) and cortisol response to corticotropin test (Delta) were measured during the first 24 h following onset of shock. The relationship between adrenal function test results and survival was analyzed as well as the effect of etomidate anesthesia. Cortisol plasma level at t (0) was higher in nonsurvivors than in survivors (33 +/- 23 vs. 25 +/- 14 microg/dl), but the response to corticotropin test did not differ between these two subgroups. ROC analysis showed threshold values for t (0) (32 microg/dl) and Delta (8 microg/dl) that best discriminated survivors from nonsurvivors in our population. We observed no difference in survival at the end of hospital stay using log rank test when patients were separated according to t (0), Delta, or both. In addition, adrenal function tests and survival did not differ in patients who received etomidate anesthesia (n = 69) during the surgical treatment of their abdominal sepsis.
In this cohort of patients with abdominal septic shock baseline cortisol level and the response to corticotropin test did not discriminate survivors from nonsurvivors. No deleterious impact of etomidate anesthesia on adrenal function tests and survival was observed in these patients.</description><subject>Abdomen</subject><subject>Adrenal Glands - physiopathology</subject><subject>Adrenocorticotropic Hormone</subject><subject>Aged</subject><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anesthetics, Intravenous</subject><subject>Biological and medical sciences</subject><subject>Blood</subject><subject>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</subject><subject>Emergency and intensive care: infection, septic shock</subject><subject>Etomidate</subject><subject>Female</subject><subject>Hormones</subject><subject>Hospitals</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>Hydrocortisone - blood</subject><subject>Infections</subject><subject>Intensive care</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units</subject><subject>Intubation</subject><subject>Laparotomy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Sepsis</subject><subject>Shock, Septic - mortality</subject><subject>Shock, Septic - physiopathology</subject><subject>Shock, Septic - surgery</subject><subject>Survival analysis</subject><subject>Survival Rate</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNpdkMFKJDEQhsOyss6qD-BFwoJ7a00l6aTHm4i7CoIX9yghnU6caE-nTXUr-_ZmmAHBU_0U31dQPyHHwM6AMX2OjIGQVYkV05pV8htZgBS8Ai6a72TBhOSVVJLvk5-Iz4XWqoYfZL9MaCToBXm87LIfbE-zxzEN6Gkc6Gin6IcJ6XucVhT9OEVHcZXcC02B2rZL67hxUo5PBb8ocl-Uoq_iSKdEcc5v8c32h2Qv2B790W4ekH9_rh-ubqq7-7-3V5d3lRO1mqrQLkWoHVO-W0oLmjVBNkIH0EG2qqlFJ5ksy9qJIEFCx1uteK1CAJCtbcQB-b29O-b0OnuczDqi831vB59mNKoRjAsuCvjrC_ic5lx-QcNBcWjYsi4QbCGXE2L2wYw5rm3-b4CZTfFmW7zZxE3xRhbnZHd4bte--zR2TRfgdAdYdLYP2Q4u4ie3BFFzrsQHKdeKag</recordid><startdate>20071001</startdate><enddate>20071001</enddate><creator>RICHE, Florence C</creator><creator>BOUTRON, Carole M</creator><creator>CHOLLEY, Bernard P</creator><creator>VALLEUR, Patrice</creator><creator>BERTON, Christine</creator><creator>LAISNE, Marie-Josèphe</creator><creator>LAUNAY, Jean-Marie</creator><creator>CHAPPUIS, Philippe</creator><creator>PEYNET, Jacqueline</creator><creator>VICAUT, Eric</creator><creator>PAYEN, Didier</creator><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20071001</creationdate><title>Adrenal response in patients with septic shock of abdominal origin : relationship to survival</title><author>RICHE, Florence C ; BOUTRON, Carole M ; CHOLLEY, Bernard P ; VALLEUR, Patrice ; BERTON, Christine ; LAISNE, Marie-Josèphe ; LAUNAY, Jean-Marie ; CHAPPUIS, Philippe ; PEYNET, Jacqueline ; VICAUT, Eric ; PAYEN, Didier</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-fb93f5c06ed94a1708f4837f17f4b6853d40408f5c3f4141d2b76256ff114ba83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Abdomen</topic><topic>Adrenal Glands - physiopathology</topic><topic>Adrenocorticotropic Hormone</topic><topic>Aged</topic><topic>Anesthesia</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anesthetics, Intravenous</topic><topic>Biological and medical sciences</topic><topic>Blood</topic><topic>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</topic><topic>Emergency and intensive care: infection, septic shock</topic><topic>Etomidate</topic><topic>Female</topic><topic>Hormones</topic><topic>Hospitals</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>Hydrocortisone - blood</topic><topic>Infections</topic><topic>Intensive care</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units</topic><topic>Intubation</topic><topic>Laparotomy</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Sepsis</topic><topic>Shock, Septic - mortality</topic><topic>Shock, Septic - physiopathology</topic><topic>Shock, Septic - surgery</topic><topic>Survival analysis</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>RICHE, Florence C</creatorcontrib><creatorcontrib>BOUTRON, Carole M</creatorcontrib><creatorcontrib>CHOLLEY, Bernard P</creatorcontrib><creatorcontrib>VALLEUR, Patrice</creatorcontrib><creatorcontrib>BERTON, Christine</creatorcontrib><creatorcontrib>LAISNE, Marie-Josèphe</creatorcontrib><creatorcontrib>LAUNAY, Jean-Marie</creatorcontrib><creatorcontrib>CHAPPUIS, Philippe</creatorcontrib><creatorcontrib>PEYNET, Jacqueline</creatorcontrib><creatorcontrib>VICAUT, Eric</creatorcontrib><creatorcontrib>PAYEN, Didier</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>RICHE, Florence C</au><au>BOUTRON, Carole M</au><au>CHOLLEY, Bernard P</au><au>VALLEUR, Patrice</au><au>BERTON, Christine</au><au>LAISNE, Marie-Josèphe</au><au>LAUNAY, Jean-Marie</au><au>CHAPPUIS, Philippe</au><au>PEYNET, Jacqueline</au><au>VICAUT, Eric</au><au>PAYEN, Didier</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adrenal response in patients with septic shock of abdominal origin : relationship to survival</atitle><jtitle>Intensive care medicine</jtitle><addtitle>Intensive Care Med</addtitle><date>2007-10-01</date><risdate>2007</risdate><volume>33</volume><issue>10</issue><spage>1761</spage><epage>1766</epage><pages>1761-1766</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><coden>ICMED9</coden><abstract>To evaluate the prognostic value of adrenocortical response to corticotropin in septic shock patients operated on exclusively for an intra-abdominal source of infection.
Prospective, observational, single-center study in a surgical intensive care unit of a university hospital
118 consecutive septic shock patients undergoing laparotomy or drainage for intra-abdominal infection.
Baseline cortisol (t (0)) and cortisol response to corticotropin test (Delta) were measured during the first 24 h following onset of shock. The relationship between adrenal function test results and survival was analyzed as well as the effect of etomidate anesthesia. Cortisol plasma level at t (0) was higher in nonsurvivors than in survivors (33 +/- 23 vs. 25 +/- 14 microg/dl), but the response to corticotropin test did not differ between these two subgroups. ROC analysis showed threshold values for t (0) (32 microg/dl) and Delta (8 microg/dl) that best discriminated survivors from nonsurvivors in our population. We observed no difference in survival at the end of hospital stay using log rank test when patients were separated according to t (0), Delta, or both. In addition, adrenal function tests and survival did not differ in patients who received etomidate anesthesia (n = 69) during the surgical treatment of their abdominal sepsis.
In this cohort of patients with abdominal septic shock baseline cortisol level and the response to corticotropin test did not discriminate survivors from nonsurvivors. No deleterious impact of etomidate anesthesia on adrenal function tests and survival was observed in these patients.</abstract><cop>Heidelberg</cop><cop>Berlin</cop><pub>Springer</pub><pmid>17618417</pmid><doi>10.1007/s00134-007-0770-4</doi><tpages>6</tpages></addata></record> |
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| subjects | Abdomen Adrenal Glands - physiopathology Adrenocorticotropic Hormone Aged Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anesthetics, Intravenous Biological and medical sciences Blood Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care Emergency and intensive care: infection, septic shock Etomidate Female Hormones Hospitals Hospitals, University Humans Hydrocortisone - blood Infections Intensive care Intensive care medicine Intensive Care Units Intubation Laparotomy Male Medical sciences Predictive Value of Tests Prospective Studies Sepsis Shock, Septic - mortality Shock, Septic - physiopathology Shock, Septic - surgery Survival analysis Survival Rate |
| title | Adrenal response in patients with septic shock of abdominal origin : relationship to survival |
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