Critical illness-related corticosteroid insufficiency in patients with severe acute biliary pancreatitis: a prospective cohort study View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2009-08

AUTHORS

Yun-Shing Peng, Cheng-Shyong Wu, Yung-Chang Chen, Jau-Min Lien, Ya-Chung Tian, Ji-Tseng Fang, Chun Yang, Yun-Yi Chu, Chien-Fu Hung, Chih-Wei Yang, Pang-Chi Chen, Ming-Hung Tsai

ABSTRACT

INTRODUCTION: Gallstones are the most common cause of acute pancreatitis worldwide. Patients with severe acute biliary pancreatitis (SABP) constitute a subgroup of severe acute pancreatitis (SAP) patients in whom systemic inflammation may be triggered and perpetuated by different mechanisms. The aim of this prospective investigation was to examine the adrenal response to corticotropin and the relationship between adrenal function and outcome in patients with SABP. METHODS: Thirty-two patients with SABP were enrolled in this study. A short corticotropin (250 microg) stimulation test (SST) was performed within the first 24 hours of admission to the ICU. Critical illness related corticosteroid insufficiency (CIRCI) was defined as follows: baseline value less than 10 microg/dL, or cortisol response less than 9 microg/dL. RESULTS: CIRCI occurred in 34.4% of patients. The patients with CIRCI were more severely ill as evidenced by higher APACHE II and SOFA scores and numbers of organ system dysfunction on the day of SST. The in-hospital mortality for the entire group was 21.9%. The CIRCI group had a higher hospital mortality rate compared to those with normal adrenal function (45.5% vs. 9.5%, P = 0.032). The hospital survivors had a higher cortisol response to corticotropin (17.4 (8.3-27.1) vs. 7.2 (1.7-12) microg/dL, P = 0.019). The cortisol response to corticotropin inversely correlated with SOFA score and the number of organ dysfunction on the day of SST. The rates of pancreatic necrosis and bacteremia were significantly higher in the CIRCI group (100% vs 42.9%, P = 0.002; 81.8% vs 23.8%, P = 0.003, respectively). CONCLUSIONS: CIRCI is common in patients with SABP. It is associated with bacteremia, multiple organ dysfunction and increased mortality. More... »

PAGES

r123

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/cc7978

DOI

http://dx.doi.org/10.1186/cc7978

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1006002995

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/19630953


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