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Adrenal insufficiency evaluation by using Iow-dose ACTH stimulation test in critical illness children

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Author:
No author available
Journal Title:
Chinese Journal of Emergency Medicine
Issue:
5
DOI:
10.3760/cma.j.issn.1671-0282.2012.05.008
Key Word:
危重病;肾上腺功能障碍;危重病相关性肾上腺皮质功能障碍;ACTH刺激实验;儿童;Critical illness;Adrenal insufficiency;Critical illness related cortisol insufficiency (CIRCI);ACTH stimulation test;Child

Abstract: Objective To evaluate the validity of original plasma cortisol level and responses to lowdose ACTH stimulation test in assessing the severity of critical illness.Method Original level of cortisol and cortisol concentrations 30 min after administration of a low dose ( 1 μg/1.73m2 ) of cosyntropin were determined within 24 hours after admission to our PICU.Critical illness related cortisol insufficiency was defined by initial level of cortisol < 10 μg/dL or an increment cortisol [ Δmax =Stimulated plasma cortisol level (T1) -initial cortisol level (T0)]≤ 9 μg/dL.Results Ninety-five consecutive patients were admitted to PICU from May 2010 to April 2011.The patients were assigned to severe sepsis group (35/95),major operation group (30/95),and other critical illness group (30/95).Overall mortality was 12.6% (12/95).The initial and stimulated plasma cortisol levels in three groups were (37.17 ± 47.35 ) μg/dL,(31.52±52.78) μg/dL,(28.61 ±17.45) μg/dL,vs.(50.26±48.21) μg/dL,(58.56±73.21)μg/dL, (42.41 ± 13.56) μg/dL,respectively.There were no significantly differences between above groups ( P > 0.05 ).The incidence of critical illness-related corticosteroid insufficiency (CIRCI) in this study was 55.8%.The incidences of CIRCI were 60%,53.3%,and 53.3% in severe sepsis,other critical illness and major surgery illness,respectively ( P > 0.05 ).The morbidity of CIRCI and normal response group were 7.5% and 19% (P >0.05).The levels of T0 and T1 were related to the PCIS (P <0.05). Conclusions CIRCI is often seen in children with critical illness. And a low-dose ACTH stimulation test can be used to evaluate the adrenal function in critical illness.However,there is no significant correlation between CIRCI and mortality of critically ill children in this study.

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