Evidence of altered cortisol metabolism in critically ill patients: a prospective study

Venkatesh, Bala, Cohen, Jeremy, Hickman, Ingrid, Nisbet, Janelle, Thomas, Peter, Ward, Gregory, Hall, Jonathan and Prins, John (2007) Evidence of altered cortisol metabolism in critically ill patients: a prospective study. Intensive Care Medicine, 33 10: 1746-1753. doi:10.1007/s00134-007-0727-7

Author Venkatesh, Bala
Cohen, Jeremy
Hickman, Ingrid
Nisbet, Janelle
Thomas, Peter
Ward, Gregory
Hall, Jonathan
Prins, John
Title Evidence of altered cortisol metabolism in critically ill patients: a prospective study
Journal name Intensive Care Medicine   Check publisher's open access policy
ISSN 0342-4642
Publication date 2007-06-01
Sub-type Article (original research)
DOI 10.1007/s00134-007-0727-7
Volume 33
Issue 10
Start page 1746
End page 1753
Total pages 8
Editor L. Brochard
Place of publication New York
Publisher Springer
Language eng
Subject C1
110310 Intensive Care
Abstract Context: Changes in cortisol metabolism due to altered activity of the enzyme 11 beta-hydroxysteroid dehydrogenase (11 beta- HSD) have been implicated in the pathogenesis of hypertension, obesity and the metabolic syndrome. No published data exist on the activity of this enzyme in critical illness. Objective: To investigate cortisol metabolism in critically ill patients utilising plasma cortisol: cortisone ratio as an index of 11 beta-HSD activity. Setting: Tertiary level intensive care unit. Patients: Three cohorts of critically ill patients: sepsis ( n = 13); multitrauma (n = 20); and burns (n = 19). Main outcome measures: Serial plasma cortisol: cortisone ratios. Measurements and main results: Plasma total cortisol cortisone ratios were determined serially after admission to the intensive care unit. As compared with controls, the plasma cortisol: cortisone ratio was significantly elevated in the sepsis and trauma cohorts on day 1 (22 +/- 9, p = 0.01, and 23 +/- 19, p = 0.0003, respectively) and remained elevated over the study period. Such a relationship was not demonstrable in burns. The ratio was significantly correlated with APACHE II (r = 0.77, p = 0.0008) and Simplified Acute Physiology Score (r = 0.7, p = 0.003) only on day 7 and only in the burns cohort. There were no significant correlations observed between total plasma cortisol or cortisone and sickness severity in the sepsis and trauma cohorts. Conclusions: In critically ill patients, there is evidence of altered cortisol metabolism due to an increase in 11 beta-HSD activity as demonstrated by an elevation of plasma cortisol: cortisone ratios. Further studies with larger sample sizes specifically designed to examine altered tissue 11 beta-HSD activity and its clinical significance and correlation with outcome are warranted.
Keyword Critical Care Medicine
11 beta-hydroxysteroid dehydrogenase
Septic shock
Critical illness
Cortisol-cortisone ratios
11-beta-hydroxysteroid Dehydrogenase Type-1
Acute-phase Response
Septic Shock
Adrenal Insufficiency
Serum Cortisol
Burn Injury
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 25 times in Thomson Reuters Web of Science Article | Citations
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Created: Tue, 19 Feb 2008, 01:09:19 EST