TY - JOUR
T1 - The low-dose corticotropin stimulation test in acute traumatic and non-traumatic brain injury
T2 - Incidence of hypo-responsiveness and relationship to outcome
AU - Dimopoulou, Ioanna
AU - Tsagarakis, Stylianos
AU - Douka, Evangelia
AU - Zervou, Maria
AU - Kouyialis, Andreas T.
AU - Dafni, Urania
AU - Thalassinos, Nikolaos
AU - Roussos, Charis
PY - 2004/6
Y1 - 2004/6
N2 - Objective: To investigate adrenal responses to the low-dose corticotropin (ACTH) stimulation test in acute traumatic or non-traumatic brain injury (BI) and to assess its value in predicting outcome. Design: Prospective study. Setting: Intensive care unit (ICU) in a university hospital. Patients and participants: Seventy-five patients with acute BI, with a median age of 45 years were investigated. BI was due to trauma (n=51), ischemic stroke (n=17), subarachnoid hemorrhage (n=4) or intracerebral hemorrhage (n=3). Interventions: Blood was taken on day 16 (median) after admission to the ICU to determine baseline cortisol and ACTH. Thereafter, a low-dose stimulation test (LDST) was performed: 1 μg of tetracosactrin was injected and 30 min later a second blood specimen was obtained to measure stimulated cortisol. Patients having a stimulated cortisol below 500 nmol/l were defined as non-responders to the LDST. Measurements and results: Median baseline and stimulated cortisol were 491 nmol/l and 690 nmol/l, respectively. The median increment in cortisol was 154 nmol/l (range 5-579 nmol/l). Mean ACTH was 46±21 pg/ml. Ten (13%) patients were non-responders to the LDST; these had a higher mortality rate compared to patients with adequate cortisol production (70 vs 32%, p=0.034). Logistic regression analysis revealed that APACHE II (p<0.001), Glasgow Coma Scale (GCS) (p=0.04) and age (p=0.02) were independent outcome predictors. In contrast, the increment in cortisol (p=0.26) did not add to outcome prediction. Conclusions: Adrenal hypo-responsiveness in the setting of acute traumatic or non-traumatic BI is not an independent outcome predictor in the presence of high APACHE II, low GCS and older age.
AB - Objective: To investigate adrenal responses to the low-dose corticotropin (ACTH) stimulation test in acute traumatic or non-traumatic brain injury (BI) and to assess its value in predicting outcome. Design: Prospective study. Setting: Intensive care unit (ICU) in a university hospital. Patients and participants: Seventy-five patients with acute BI, with a median age of 45 years were investigated. BI was due to trauma (n=51), ischemic stroke (n=17), subarachnoid hemorrhage (n=4) or intracerebral hemorrhage (n=3). Interventions: Blood was taken on day 16 (median) after admission to the ICU to determine baseline cortisol and ACTH. Thereafter, a low-dose stimulation test (LDST) was performed: 1 μg of tetracosactrin was injected and 30 min later a second blood specimen was obtained to measure stimulated cortisol. Patients having a stimulated cortisol below 500 nmol/l were defined as non-responders to the LDST. Measurements and results: Median baseline and stimulated cortisol were 491 nmol/l and 690 nmol/l, respectively. The median increment in cortisol was 154 nmol/l (range 5-579 nmol/l). Mean ACTH was 46±21 pg/ml. Ten (13%) patients were non-responders to the LDST; these had a higher mortality rate compared to patients with adequate cortisol production (70 vs 32%, p=0.034). Logistic regression analysis revealed that APACHE II (p<0.001), Glasgow Coma Scale (GCS) (p=0.04) and age (p=0.02) were independent outcome predictors. In contrast, the increment in cortisol (p=0.26) did not add to outcome prediction. Conclusions: Adrenal hypo-responsiveness in the setting of acute traumatic or non-traumatic BI is not an independent outcome predictor in the presence of high APACHE II, low GCS and older age.
KW - Cortisol
KW - Critical illness
KW - Head trauma
KW - Low-dose corticotropin stimulation test
KW - Outcome prediction
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=3042633851&partnerID=8YFLogxK
U2 - 10.1007/s00134-004-2297-2
DO - 10.1007/s00134-004-2297-2
M3 - Article
C2 - 15103462
AN - SCOPUS:3042633851
SN - 0342-4642
VL - 30
SP - 1216
EP - 1219
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 6
ER -