Prospective Study Exploring The Relationship Between The Plasma Cortisol And The Prognosis Of Critical Patients

Objective To investigate the relationship between the plasma cortisol andthe prognosis of critical ill patients. Analysis the influencing factors of CORlevels during the stress period (including age, infection, shock factor et al),and provide the reference condition assessment, treatment and prognosis forclinical.Methods Cortisol monitoring was performed for the adult patients admittingin intensive care unit(ICU) of General Hospital of Ningxia Medical Universityform April2012to June2012, Collected clinical Information and observe theprognosis for28days.All the datas was within24hours.Acute physiology andchronic health evaluationⅡ(APACHEⅡ) and Sequential Organ Failure Assessment(SOFA) scores to evaluate the severity of illness and organ function whentransferred into ICU.Patients was divided into3groups based on the COR,meanof COR, APACHEⅡscore and28-day mortality were compared among groups. Patientswas divided into survival and non-survival group,the age,gender and COR wascompared. Analyzed influence factors respectively from three aspects: the agefactor,infection,shock factor. Patients was divided into2groups based on theCOR,look for the relationship between COR and ACTH.Results Total99cases were enrolled. The overall level of COR was low,≤15.0μg/dL accounted for58%.(1) Compared between groups which according toCOR levels, its average COR, APACHE Ⅱ score,28d fatality rate were significantdifference (P<0.01), and with COR level increased, the higher APACHE Ⅱ score, the longer mechanical ventilation time and ICU hospitalization time,28dfatality rate had a tendency to increased gradually.(2) Compared with survivalgroup(n=78),in the non-survival group(n=21),the level of COR, APACHEⅡ,SOFAhad the difference of statistics (p<0.05).(3) Among three groups according toage, the average COR is statistically difference(P <0.05), as the growth ofthe age, COR levels decreased, the average COR was significant lower in thepatients≥50years old than≤30years old(P<0.01).(4) Grouped by infection,shock, the average COR of three groups statistically significant difference(P<0.01), the COR level of septic shock patients was higher than patients innon-sepsis and sepsis group (P<0.01).(5)Of all the patients,only30cases hadthe ACTH,ACTH was higher as well as COR.Conclusion1.The level of COR of critcal patients was low,≤15μg/dlaccounted for58%.2.As COR level increased, the illness aggravating gradually,the worse prognosis.3.As age increased,the COR decreased.4.The COR of criticalpatients was effected by infection and shock.In the septic shock patients,thesepetients were more who had a higher COR level.