ArticleCritical care explorations2024
Cortisol Levels During First Admission Day Are Associated With Clinical Outcomes in Surgical Critically Ill Patients.
Article in Critical care explorations, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Article
- Oral transmucosal fentanyl citrate analgesia in prehospital trauma care: a retrospective observational cohort study focusing on age and gender differences.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026Observational
- Breaking Through Difficult-to-Control T2D: Targeting Hypercortisolism.Federal practitioner : for the health care professionals of the VA, DoD, and PHS · 2025Article
- Causes and Effects of Postoperative Sleep Disorders and Treatment Strategies for Preoperative, Intraoperative, and Postoperative Settings-A Narrative Review.Clocks & sleep · 2025Review
- Hypercortisolism Is More Common Than You Think-Here's How to Find It.Federal practitioner : for the health care professionals of the VA, DoD, and PHS · 2024Article
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
importanceTo explore the correlation between cortisol levels during first admission day and clinical outcomes.
objectivesAlthough most patients exhibit a surge in cortisol levels in response to stress, some suffer from critical illness-related corticosteroid insufficiency (CIRCI). Literature remains inconclusive as to which of these patients are at greater risk of poor outcomes.
designA retrospective study.
settingA surgical ICU (SICU) in a tertiary medical center.
participantsCritically ill patients admitted to the SICU who were not treated with steroids. MAIN OUTCOMES AND MEASURES: Levels of cortisol taken within 24 hours of admission (day 1 [D1] cortisol) in 1412 eligible patients were collected and analyzed. Results were categorized into four groups: low (0-10 µg/dL), normal (10-25 µg/dL), high (25-50 µg/dL), and very high (above 50 µg/dL) cortisol levels. Primary endpoint was 90-day mortality. Secondary endpoints were the need for organ support (use of vasopressors and mechanical ventilation [MV]), ICU length of stay (LOS), and duration of MV.
resultsThe majority of patients (63%) had high or very high D1 cortisol levels, whereas 7.6% had low levels and thus could be diagnosed with CIRCI. There were statistically significant differences in 90-day mortality between the four groups and very high levels were found to be an independent risk factor for mortality, primarily in patients with Sequential Organ Failure Assessment (SOFA) less than or equal to 3 or SOFA greater than or equal to 7. Higher cortisol levels were associated with all secondary endpoints. CIRCI was associated with favorable outcomes. CONCLUSIONS AND RELEVANCE: In critically ill surgical patients D1 cortisol levels above 50 mcg/dL were associated with mortality, need for organ support, longer ICU LOS, and duration of MV, whereas low levels correlated with good clinical outcomes even though untreated. D1 cortisol level greater than 50 mcg/dL can help discriminate nonsurvivors from survivors when SOFA less than or equal to 3 or SOFA greater than or equal to 7.
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