TY - JOUR
T1 - Activation of pituitary axis according to underlying critical illness and its effect on outcome
AU - Mazzeo, Anna Teresa
AU - Guaraldi, Federica
AU - Filippini, Claudia
AU - Tesio, Rachele
AU - Settanni, Fabio
AU - Lucchiari, Manuela
AU - Mengozzi, Giulio
AU - Grottoli, Silvia
AU - Ghigo, Ezio
AU - Mascia, Luciana
N1 - Ricercatore distaccato presso IRCCS a seguito Convenzione esclusiva con Università di Bologna (Guaraldi Federica).
Richiesto CORRIGENDUM per modifica di affiliazione.
PY - 2019/12
Y1 - 2019/12
N2 - Purpose: Critical illness is a life threatening condition inducing a severe acute physical stress. The aim of the study was to investigate the activation of pituitary axis early after ICU admission in patients with critical illnesses of different etiology and its association with outcome. Materials and methods: Patients admitted for acute respiratory distress syndrome (ARDS), severe traumatic brain injury (TBI), subarachnoid hemorrhage (SAH) and neurocritically ill patients at the moment of brain death (BD) diagnosis were included in the present post-hoc analysis. On day 1, 2–3 and 4–5 after admission the following pituitary axes were assessed: hypothalamic-pituitary-adrenal, hypothalamic-pituitary-thyroid, somatotroph, prolactin and copeptin. ICU mortality was used as outcome measure. Results: One hundred-thirteen critical ill patients were studied. Thyroid axis suppression and activation of copeptin axis were the most frequent pituitary hormone alterations, present in almost 60% of patients. Activation of the hypothalamic pituitary adrenal axis was a predictor of ICU mortality independently from the underlying critical illness [OR 3.952 (C.I.95% 1.129–13.838)]. Conclusions: Pituitary axis function is frequently altered early after ICU admission, the magnitude of hormonal response being different according to the underlying critical illness. The activation of the hypothalamic pituitary adrenal axis was a strong predictor of ICU mortality.
AB - Purpose: Critical illness is a life threatening condition inducing a severe acute physical stress. The aim of the study was to investigate the activation of pituitary axis early after ICU admission in patients with critical illnesses of different etiology and its association with outcome. Materials and methods: Patients admitted for acute respiratory distress syndrome (ARDS), severe traumatic brain injury (TBI), subarachnoid hemorrhage (SAH) and neurocritically ill patients at the moment of brain death (BD) diagnosis were included in the present post-hoc analysis. On day 1, 2–3 and 4–5 after admission the following pituitary axes were assessed: hypothalamic-pituitary-adrenal, hypothalamic-pituitary-thyroid, somatotroph, prolactin and copeptin. ICU mortality was used as outcome measure. Results: One hundred-thirteen critical ill patients were studied. Thyroid axis suppression and activation of copeptin axis were the most frequent pituitary hormone alterations, present in almost 60% of patients. Activation of the hypothalamic pituitary adrenal axis was a predictor of ICU mortality independently from the underlying critical illness [OR 3.952 (C.I.95% 1.129–13.838)]. Conclusions: Pituitary axis function is frequently altered early after ICU admission, the magnitude of hormonal response being different according to the underlying critical illness. The activation of the hypothalamic pituitary adrenal axis was a strong predictor of ICU mortality.
KW - Acute respiratory distress syndrome
KW - Brain death
KW - Intensive care
KW - Neuroendocrine dysfunction
KW - Subarachnoid hemorrhage
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85069492840&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85069492840&partnerID=8YFLogxK
U2 - 10.1016/j.jcrc.2019.07.006
DO - 10.1016/j.jcrc.2019.07.006
M3 - Article
C2 - 31326617
AN - SCOPUS:85069492840
VL - 54
SP - 22
EP - 29
JO - Journal of Critical Care
JF - Journal of Critical Care
SN - 0883-9441
ER -