scholarly journals Prospective evaluation of admission cortisol in trauma

2020 ◽  
Vol 5 (1) ◽  
pp. e000386
Author(s):  
Amy M Kwok ◽  
James W Davis ◽  
Rachel C Dirks ◽  
Lawrence P Sue ◽  
Mary M Wolfe ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Cortisol Level ◽  
Blood Product ◽  
Total Serum ◽  
Trauma Patients ◽  
Blood Draw ◽  
Cortisol Levels ◽  
Low Cortisol ◽  
Vasopressor Use ◽  
The Impact

BackgroundA low cortisol level has been shown to occur soon after trauma, and is associated with increased mortality. The purpose of this study was to investigate the impact of low cortisol levels in acute critically ill trauma patients. We hypothesized that patients would require increase vasopressor use, have a greater blood product administration, and increased mortality rate.MethodsA blinded, prospective observational study was performed at an American College of Surgeons verified Level I trauma center. Adult patients who met trauma activation criteria, received initial treatment at Community Regional Medical Center and were admitted to the intensive care unit were included. Total serum cortisol levels were measured from the initial blood draw in the emergency department. Patients were categorized according to cortisol ≤15 µg/dL (severe low cortisol, SLC), 15.01–25 µg/dL (relative low cortisol, RLC), or >25 µg/dL (normal cortisol, NC) and compared on demographics, injury severity score, initial vital signs, blood product usage, vasopressor requirements, and mortality.ResultsCortisol levels were ordered for 280 patients; 91 were excluded and 189 were included. Penetrating trauma accounted for 19% of injuries and blunt trauma for 81%. 22 patients (12%) had SLC, 83 (44%) had RLC, and 84 (44%) had NC. This study found patients with admission SLC had higher rates of vasopressor requirements, required more units of blood, and had a higher mortality rate than both the RLC and NC groups.ConclusionLow cortisol level can be identified acutely after severe trauma. Trauma patients with SLC had larger blood product requirements, vasopressor use, and increase mortality. Initial cortisol levels are useful in identifying these high-risk patients.Level of evidencePrognostic/epidemiologic study, level III

Increased Total Serum Random Cortisol Levels Predict Mortality in Critically Ill Trauma Patients

2014 ◽  
Vol 80 (11) ◽  
pp. 1112-1118 ◽  
Author(s):  
Urmil Pandya ◽  
Nathan Polite ◽  
Teresa Wood ◽  
Michael Lieber
Keyword(s):  
Injury Severity Score ◽  
Critically Ill ◽  
Cortisol Level ◽  
Severity Score ◽  
Odds Ratio ◽  
Injury Severity ◽  
Serum Cortisol ◽  
Total Serum ◽  
Trauma Patients ◽  
Cortisol Levels

Dysfunction in the hypothalamopituitary adrenal axis is thought to exist; however, there continues to be controversy about what level of serum cortisol corresponds to adrenal insufficiency. Few studies have focused on the significance of serum random cortisol in the critically ill trauma patient. Trauma patients with total serum random cortisol levels drawn in the intensive care unit within the first seven days of hospitalization were retrospectively reviewed. The primary outcome measured was in-hospital mortality. Two hundred forty-two patients were analyzed. Non-survivors had significantly higher mean cortisol levels than survivors (28.7 ± 15.80 mg/dL vs 22.9 ± 12.35 mg/dL, P = 0.01). Patients with cortisol 30 mg/dL or greater were more likely to die with odds ratio of 2.7 (95% confidence interval [CI], 1.5 to 5). The odds ratio increased to 4.0 and 3.8 (95% CI, 1.4 to 11.4 and 1.3 to 10.9) when cortisol was drawn on hospital Day 2 and Days 3 through 7, respectively. Among nonsurvivors, patients with an injury severity score less than 25 had significantly higher cortisol levels than patients with an Injury Severity Score 25 or higher (35.3 ± 19.21 mg/dL vs 25.7 ± 13.21 mg/dL, P = 0.009). Patients with massive transfusion, traumatic brain injury, spinal cord injury, or solid organ injury did not have significantly different cortisol levels. The covariate-adjusted area under the receiver operating characteristic curve indicated that cortisol level has a 77 per cent accuracy in differentiating survivors from nonsurvivors. Higher cortisol levels were predictive of mortality in critically ill trauma patients. Whether serum cortisol level is a marker that can be modified remains an area of interest for future study.

Adrenal Insufficiency in the Critically Ill Trauma Population

2006 ◽  
Vol 72 (5) ◽  
pp. 373-376 ◽  
Author(s):  
T.A. Gannon ◽  
R.C. Britt ◽  
L.J. Weireter ◽  
F.J. Cole ◽  
J.N. Collins ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Critically Ill ◽  
Serum Cortisol ◽  
Total Serum ◽  
Trauma Patients ◽  
Total N ◽  
Trauma Population ◽  
Number Of Patients ◽  
Low Cortisol ◽  
The Impact

Acute adrenal insufficiency has been demonstrated in a number of patients with shock. This study was designed to evaluate the rate of occult adrenal insufficiency in the critically ill trauma population and to determine the impact of hypoproteinemia on the use of random cortisol levels as a marker for adrenal insufficiency. Forty-four patients were prospectively enrolled on admission to the trauma intensive care unit, with three excluded, for a total n of 41. Random total serum cortisol and albumin levels were drawn on hospital Days 1, 4, 8, and 14. Occult adrenal insufficiency was defined as a cortisol less than 25 mcg/dL in the setting of an albumin greater than 2.5 g/dL. The prevalence of cortisol less than 25 mcg/dL ranged from 51 to 81 per cent during the study period, and peaked on Days 4 and 8. Albumin 2.5 g/dL or less ranged from 37 to 60 per cent, and this prevalence also peaked on Days 4 and 8. The patients with a low albumin had a high prevalence of low cortisol, ranging from 67 to 100 per cent. The prevalence of adrenal insufficiency, with low cortisol and normal albumin, ranged from 41 to 82 per cent during the study period. None of our patients with occult adrenal insufficiency were treated with steroids, which was a decision made by the treating physicians. Among the patients with occult adrenal insufficiency, survival was 100 per cent. Occult adrenal insufficiency is common in critically ill trauma patients, and is a dynamic entity that can be acquired and even resolved during critical illness. Random cortisol of 25 mcg/dL may actually not be an adequate marker of occult adrenal insufficiency. Low albumin predicts a low cortisol. Hemodynamically stable occult adrenal insufficiency should not be treated with steroid replacement in the critically ill trauma patient, as survival in our series was 100 per cent without replacement.

scholarly journals An approach to stress assessment during hunting: Cortisol levels of wild boar (Sus scrofa) during drive hunts

2020 ◽  
Author(s):  
Justine Güldenpfennig ◽  
Marion Schmicke ◽  
Martina Hoedemaker ◽  
Ursula Siebert ◽  
Oliver Keuling
Keyword(s):  
Wild Boar ◽  
Cortisol Level ◽  
Age Groups ◽  
Serum Cortisol ◽  
Well Being ◽  
Lower Saxony ◽  
Pregnant Females ◽  
Wildlife Species ◽  
Cortisol Levels ◽  
The Impact

AbstractOnly little is known about the effect of stress (both short-term and long-term) on wildlife species. To get an idea of stress in wildlife, we investigated the cortisol level of wild boar during drive hunts in Lower Saxony, Germany. Cortisol as one of the main stress hormone in mammals is considered to have negative impacts on the animal’s well-being if expressed excessively (repeatedly over a longer period). We analysed serum cortisol levels of 115 samples using a radioimmunoassay and compared sampling month, hunting grounds, age classes and sexes, as well as possible correlations between cortisol level and weight and pregnancy status of female wild boar. We found that cortisol levels during these drive hunts exhibit wide variation. The mean cortisol level was 411.16 nmol/L with levels ranging from 30.60 nmol/L (minimum) to 1,457.92 nmol/L (maximum). Comparing age groups and sexes, we found significant differences between the sexes, with females having a higher cortisol levels than males. After grouping age groups and sexes together, we also found significant differences based on the age-sex group. We found no correlation between cortisol levels and weight, but significantly higher cortisol levels in pregnant females compared to non-pregnant females. No differences were found between sampling months and locations, respectively. These results show the impact of drive hunts on stress in wild boar; nevertheless, this impact of drive hunts as performed in most parts of Central Europe seems to be not as high as imagined. Still, we need more information about cortisol levels and stress in (hunted) wildlife species.

scholarly journals Contemporary Transfusion Science and Challenges

2019 ◽  
Vol 30 (2) ◽  
pp. 139-150
Author(s):  
Heather M. Passerini
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Blood Product ◽  
Damage Control ◽  
Coagulation Factor ◽  
Trauma Patients ◽  
Transfusion Therapy ◽  
Use Of Resources ◽  
Study Results ◽  
The Impact

Health care professionals must understand the impact of blood product transfusions and transfusion therapy procedures to ensure high-quality patient care, positive outcomes, and wise use of resources in blood management programs. Understanding transfusions of blood and blood products is also important because of the number of treatments performed, which affects individual patients and health care system resources. This article reviews research findings to acquaint health care professionals with the most successful protocols for blood, blood product, and coagulation factor transfusions. Damage control resuscitation in bleeding trauma patients, protocols for patients without trauma who are undergoing surgical procedures that place them at risk for excessive bleeding, and protocols for patients with sepsis are addressed. Emerging research continues to help guide mass transfusion treatments (restrictive vs liberal, balanced, and goal-directed treatment). Although available study results provide some guidance, questions remain. Additional research by health care professionals is needed.

scholarly journals Higher Mortality Rate in Moderate-to-Severe Thoracoabdominal Injury Patients with Admission Hyperglycemia Than Nondiabetic Normoglycemic Patients

2019 ◽  
Vol 16 (19) ◽  
pp. 3562
Author(s):  
Wei-Ti Su ◽  
Shao-Chun Wu ◽  
Sheng-En Chou ◽  
Chun-Ying Huang ◽  
Shiun-Yuan Hsu ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Injury Severity ◽  
Burn Injury ◽  
Past History ◽  
Trauma Patients ◽  
Thoracoabdominal Injuries ◽  
History Of ◽  
Level 1 ◽  
The Impact ◽  
Level 1 Trauma Center

Background: Hyperglycemia at admission is associated with an increase in worse outcomes in trauma patients. However, admission hyperglycemia is not only due to diabetic hyperglycemia (DH), but also stress-induced hyperglycemia (SIH). This study was designed to evaluate the mortality rates between adult moderate-to-severe thoracoabdominal injury patients with admission hyperglycemia as DH or SIH and in patients with nondiabetic normoglycemia (NDN) at a level 1 trauma center. Methods: Patients with a glucose level ≥200 mg/dL upon arrival at the hospital emergency department were diagnosed with admission hyperglycemia. Diabetes mellitus (DM) was diagnosed when patients had an admission glycohemoglobin A1c ≥6.5% or had a past history of DM. Admission hyperglycemia related to DH and SIH was diagnosed in patients with and without DM. Patients who had a thoracoabdominal Abbreviated Injury Scale score <3, a polytrauma, a burn injury and were below 20 years of age were excluded. A total of 52 patients with SIH, 79 patients with DH, and 621 patients with NDN were included from the registered trauma database between 1 January 2009, and 31 December 2018. To reduce the confounding effects of sex, age, comorbidities, and injury severity of patients in assessing the mortality rate, different 1:1 propensity score-matched patient populations were established to assess the impact of admission hyperglycemia (SIH or DH) vs. NDN, as well as SIH vs. DH, on the outcomes. Results: DH was significantly more frequent in older patients (61.4 ± 13.7 vs. 49.8 ± 17.2 years, p < 0.001) and in patients with higher incidences of preexisting hypertension (2.5% vs. 0.3%, p < 0.001) and congestive heart failure (3.8% vs. 1.9%, p = 0.014) than NDN. On the contrary, SIH had a higher injury severity score (median [Q1–Q3], 20 [15–22] vs. 13 [10–18], p < 0.001) than DH. In matched patient populations, patients with either SIH or DH had a significantly higher mortality rate than NDN patients (10.6% vs. 0.0%, p = 0.022, and 5.3% vs. 0.0%, p = 0.043, respectively). However, the mortality rate was insignificantly different between SIH and DH (11.4% vs. 8.6%, odds ratio, 1.4; 95% confidence interval, 0.29–6.66; p = 0.690). Conclusion: This study revealed that admission hyperglycemia in the patients with thoracoabdominal injuries had a higher mortality rate than NDN patients with or without adjusting the differences in patient’s age, sex, comorbidities, and injury severity.

scholarly journals Effects of Litsea cubeba (Lour.) Persoon Essential Oil Aromatherapy on Mood States and Salivary Cortisol Levels in Healthy Volunteers

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Chaiyavat Chaiyasut ◽  
Bhagavathi Sundaram Sivamaruthi ◽  
Jakkrit Wongwan ◽  
Kanyarat Thiwan ◽  
Wandee Rungseevijitprapa ◽  
...  
Keyword(s):  
Essential Oil ◽  
Healthy Volunteers ◽  
Cortisol Level ◽  
Salivary Cortisol ◽  
Mood States ◽  
Healthy Human ◽  
Litsea Cubeba ◽  
Salivary Cortisol Level ◽  
Cortisol Levels ◽  
The Impact

Aromatherapy is one of the complementary therapies to improve health. The aromatic essential oils have been used in the treatment procedure through inhalation of essential oil vapor, massage, and herbal bathing. Litsea species are generally used in traditional medicine, and Litsea cubeba (Lour.) Persoon is a potent fumigant plant, used in cosmetics and foods as essence. The chemical composition of the essential oil of different parts of L. cubeba has been found to be varied. L. cubeba essential oil (LEO) is known for the treatment of cognition-associated discomforts. The current study assessed the impact of inhalation of LEO on mood states and salivary cortisol levels of healthy people. Fifteen healthy volunteers were involved in the study. The Profile of Mood States (POMS) Questionnaire and ELISA methods were employed to determine the mood states and salivary cortisol level, respectively. (-)-β-pinene, β-citral, cis- and trans-citral, citronellal, limonene, linalool, and 6-methyl-5-hepten-2-one were detected in LEO by GC-MS analysis. The heart rate and blood pressure were not affected significantly during LEO exposure. The inhalation of LEO significantly improved the total mood disturbance and reduced the confusion among the healthy human subjects. LEO inhalation reduced the salivary cortisol level at a notable level. The results of the current study warrant further studies on the beneficial effect of LEO aromatherapy in healthy and diseased subjects to uncover the therapeutic nature of the L. cubeba plant.

scholarly journals Blood Cortisol Level and Blood Serotonin Level in Depression Mice with Basil Leaf Essential Oil Treatment

2019 ◽  
Vol 7 (16) ◽  
pp. 2652-2655
Author(s):  
Machnizar Sentari ◽  
Urip Harahap ◽  
Tuti Wahmurti A. Sapiie ◽  
Kiking Ritarwan
Keyword(s):  
Essential Oil ◽  
Essential Oils ◽  
Cortisol Level ◽  
Work Productivity ◽  
Public Health Problem ◽  
Serotonin Level ◽  
Traditional Medicines ◽  
Leaf Essential Oil ◽  
Cortisol Levels ◽  
The Impact

BACKGROUND: Depression is a serious public health problem. The impact of depression is enormous, ranging from decreasing work productivity, interpersonal disorders, sleep and eating disorders, susceptible to disease to an increase in suicides. In a state of depression, there was an increase in cortisol and changes in the neurotransmitter of the brain monoamine, norepinephrine and dopamine and specifically serotonin level. Treatment of depression using synthetic drugs such as the Selective Serotonin Reuptake Inhibitor (SSRI) drug which is said to be safe turns out to still have side effects, such as stomach disorders, erectile disorders, weight gain and sometimes sleep disorders. So, the usage of traditional medicines can be an alternative. One of the traditional medicines that have been studied in Indonesia was the essential oil of basil leaves, which is known to function as an antidepressant at a dose of 2.5 x 10-2 mL/kg b.w. AIM: To determine the comparison of cortisol and serotonin level between depressed mice which get basil leaf essential oil as intervention, depression mice, and normal mice. METHODS: This research was an experimental type purely using experimental animal models, with an experimental research design Post Test Only Context Group Design in mice (Mus musculus), by dividing 3 groups of mice, namely depressed mice which received essential oil of basil leaves dose of 2.5 x 10-2 mL/kg BW, depression mice, and normal mice, to compare the level of blood cortisol and serotonin while to determine effect of administration basil leaves essential oils in depression mice. RESULTS: Cortisol levels between intervened depression mice, depression mice, and normal mice groups were significantly comparable with p < 0.001, while serotonin level was significantly comparable between intervened depression mice, depression mice, and normal mice group with p < 0.001. CONCLUSION: Evidenced by differences in cortisol levels, serotonin levels between normal mice groups, depressed mice and mice that received essential oils of basil leaves. The comparisons showed that the cortisol level of the intervened depression group was lower than the depression mice group; however the level didn’t reach the level of cortisol in the normal group. While the serotonin level of intervened depression mice group was higher than the depression mice group or normal mice group.

The Impact of High Cortisol Level in Increasing Incidence of Infection Cases Among Acute Stroke Patients

2020 ◽  
Vol 17 (7) ◽  
pp. 3079-3084
Author(s):  
Indah Ari Handaayani ◽  
Muhammad Hamdan ◽  
Paulus Sugianto ◽  
Achmad Firdaus Sani ◽  
Mohammad Saiful Ardhi ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Cortisol Level ◽  
Venous Blood ◽  
Serum Cortisol ◽  
Operational Definition ◽  
Serum Cortisol Level ◽  
Stroke Patients ◽  
Cortisol Levels ◽  
High Level ◽  
The Impact

Infection in the stroke was a treatment major problem, because it determines the prognosis. In the acute phase of stroke, high level cortisol may lead to a decreased immune system and patients tend to be more susceptible to infection. The correlation of serum cortisol level among acute stroke patients with incidence of infection was not fully investigated. The aim of this study was to determine the relationship between initial serum cortisol levels and the incidence of infection in acute stroke patients. A prospective cohort study was conducted on 32 of acute stroke patients who admitted in RSUD Dr. Soetomo Surabaya during the period December 2015 to February 2016. Total of 2 cc to the venous blood within 48 hours in onset of stroke being examined of serum cortisol. During the 7 days of hospitalization, the patient was observed for signs of infection, both clinically and the investigation in accordance with the operational definition. In the infected group there were 8 people (50%) with high cortisol levels (p = 0.015; RR 15,000; 95% IK 1.583-143,171); 6 people were (50%) using urine catheter (p = 0.049; RR 6,667; 95% IK 1.067-30.085); And 6 people were (54.5%) using NGT (p = 0,035; RR 7,200; 95% IK 1.311-39,557). In multivariate analysis obtained that Odds Ratio (OR) 15,468 based on high cortisol and OR 7,469 based on NGT usage. High cortisol levels and the use of NGT had the effect on the incidence of infection in acute stroke.

Acute Adrenal Insufficiency May Affect Outcome in the Trauma Patient

2009 ◽  
Vol 75 (4) ◽  
pp. 287-290 ◽  
Author(s):  
Oscar D. Guillamondegui ◽  
Oliver L. Gunter ◽  
Shivani Patel ◽  
Sloan Fleming ◽  
Bryan A. Cotton ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Trauma Patient ◽  
Adrenal Insufficiency ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Acute Adrenal Insufficiency ◽  
Stimulation Tests ◽  
Cortisol Levels ◽  
The Impact

Acute adrenal insufficiency in the trauma patient is underrecognized and the impact poorly understood. Our hypothesis was that the identification and treatment of acute adrenal insufficiency reduces mortality in trauma patients. Institutional Review Board approval for the retrospective review of a prospective database from a Level 1 trauma center for 2002 to 2004 was obtained. The study population included patients receiving a cosyntropin stimulation test (250 μg) and/or random Cortisol level based on our practice management guideline and an intensive care unit stay longer than 24 hours. Demographic, acuity, and outcome data were collected. The nonresponders had baseline Cortisol levels less than 20 μg/dL or poststimulation rise less than 9 μg/dL. Independent t tests and χ2 statistics were used. One hundred thirty-seven patients had cosyntropin stimulation tests performed. Eighty-two (60%) patients were nonresponders of which 66 were treated with hydrocortisone and 16 went untreated as a result of the discretion of the attending physician. The 55 (40%) responders showed no statistical differences in outcome variables whether or not they received hydrocortisone. The untreated adrenal-insufficient patients had significantly higher mortality, longer hospital length of stay, intensive care unit days, and ventilator-free days. Conclusions were: 1) treatment of acute adrenal insufficiency reduces mortality by almost 50 per cent in the trauma patient; and 2) acute adrenal insufficiency recognized by low random Cortisol levels or nonresponse to a stimulation tests should be considered for treatment.

scholarly journals Trauma-related Coagulopathy—Current Concepts

2012 ◽  
Vol 08 (02) ◽  
pp. 123 ◽  
Author(s):  
Paul T Engels ◽  
J Damian Paton-Gay ◽  
Sandy L Widder ◽  
◽  
◽  
...  
Keyword(s):  
Mortality Rate ◽  
Medical Treatment ◽  
Blood Product ◽  
Treatment Strategies ◽  
Early Death ◽  
Current Understanding ◽  
Targeted Treatment ◽  
Trauma Patients ◽  
New Era ◽  
Assessment Techniques

Background:Hemorrhage continues to be a major cause of early death in trauma patients. Our understanding of the development of coagulopathy and its importance has evolved significantly over the last decade. In this article, we describe the current understanding of coagulopathy in the setting of trauma including its mechanisms, diagnosis, consequences, and treatment strategies.Methods:Review of selected articles from MEDLINE.Results:The occurrence of coagulopathy is common in trauma patients and is multifactorial, with increasing evidence indicating an endogenous mechanism unrelated to the complications of medical treatment. The use of novel coagulation assessment techniques and evolution in blood product treatment strategies is generating a new era of targeted management.Conclusions:Coagulopathy in trauma is common, but newer techniques in diagnosis as well as novel methods to provide targeted treatment offer encouraging results in decreasing the mortality rate from exsanguination after injury.

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