| Title |
Adrenocortical function during prolonged critical illness and beyond: a prospective observational study
|
|---|---|
| Published in |
Intensive Care Medicine, September 2018
|
| DOI | 10.1007/s00134-018-5366-7 |
| Pubmed ID | |
| Authors |
Bram Peeters, Philippe Meersseman, Sarah Vander Perre, Pieter J. Wouters, Dimitri Vanmarcke, Yves Debaveye, Jaak Billen, Pieter Vermeersch, Lies Langouche, Greet Van den Berghe |
| Abstract |
For patients suffering from prolonged critical illness, it is unknown whether and when the hypothalamus-pituitary-adrenal axis alterations recover, and to what extent adrenocortical function parameters relate to sepsis/septic shock, to clinical need for glucocorticoid treatment, and to survival. Patients still in ICU on day 7 (N = 392) and 20 matched healthy subjects were included. Morning blood and 24-h urine were collected daily and cosyntropin tests (250 µg) performed weekly, repeated 1 week after ICU discharge on the regular ward. In all patients free of glucocorticoid treatment up until ICU day 28 (N = 347), plasma ACTH always remained low/normal, whereas free cortisol remained high (P ≤ 0.002) explained by reduced binding proteins (P ≤ 0.02) and suppressed cortisol breakdown (P ≤ 0.001). Beyond ICU day 28 (N = 64 long-stayers), plasma (free)cortisol was no longer elevated. One week after ICU discharge, plasma ACTH and (free)cortisol always rose to supra-normal levels (P ≤ 0.006), most pronounced in long-stayers. Long-stayers always showed low incremental total (P ≤ 0.001), but normal incremental free cortisol responses to weekly cosyntropin tests, explained by low cortisol plasma binding proteins. Sepsis/septic shock patients were not different from others, patients subsequently receiving glucocorticoids (N = 45) were not different from those who did not, and non-survivors were distinguishable from survivors only by higher (free)cortisol. Irrespective of sepsis/septic shock, need for glucocorticoids and survival, low cortisol plasma binding proteins and suppressed cortisol breakdown determine systemic (free)cortisol availability in prolonged critical illness, the latter no longer elevated beyond ICU day 28. The uniform rise in ACTH and cortisol to supra-normal levels 1 week after ICU discharge indicates recovery of a central adrenocortical suppression while in ICU. Low cortisol plasma binding invalidates the cosyntropin test. |
X Demographics
The data shown below were collected from the profiles of 29 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| France | 3 | 10% |
| Italy | 3 | 10% |
| United Kingdom | 2 | 7% |
| Mexico | 2 | 7% |
| Colombia | 1 | 3% |
| Switzerland | 1 | 3% |
| Spain | 1 | 3% |
| Belgium | 1 | 3% |
| Denmark | 1 | 3% |
| Other | 4 | 14% |
| Unknown | 10 | 34% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 22 | 76% |
| Practitioners (doctors, other healthcare professionals) | 4 | 14% |
| Scientists | 3 | 10% |
Mendeley readers
The data shown below were compiled from readership statistics for 78 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 78 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Bachelor | 11 | 14% |
| Student > Master | 9 | 12% |
| Other | 7 | 9% |
| Student > Ph. D. Student | 7 | 9% |
| Student > Postgraduate | 6 | 8% |
| Other | 15 | 19% |
| Unknown | 23 | 29% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 36 | 46% |
| Biochemistry, Genetics and Molecular Biology | 6 | 8% |
| Pharmacology, Toxicology and Pharmaceutical Science | 3 | 4% |
| Agricultural and Biological Sciences | 3 | 4% |
| Neuroscience | 3 | 4% |
| Other | 4 | 5% |
| Unknown | 23 | 29% |
Attention Score in Context
This research output has an Altmetric Attention Score of 15. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 02 December 2018.
All research outputs
#2,242,088
of 23,953,397 outputs
Outputs from Intensive Care Medicine
#1,671
of 5,172 outputs
Outputs of similar age
#47,140
of 341,111 outputs
Outputs of similar age from Intensive Care Medicine
#34
of 106 outputs
Altmetric has tracked 23,953,397 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 90th percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 5,172 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 28.8. This one has gotten more attention than average, scoring higher than 67% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 341,111 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 86% of its contemporaries.
We're also able to compare this research output to 106 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 68% of its contemporaries.