title: Serum cortisol as a predictive marker of the outcome in patients resuscitated after cardiopulmonary arrest.
abstract: OBJECTIVE
  To analyze the relationship between stress hormones (arginine vasopressin (ADH), adrenocorticotropic hormone (ACTH) and cortisol and the outcome of patients resuscitated after cardiopulmonary arrest (CPA).
  
  
  METHODS
  Thirty-six patients were enrolled in this study. In 36 of the resuscitated cases, 27 were non-survivors and 9 survived. The survival group was defined as cases either in a persistent vegetative state, with some disability or good recovery 1 month after return of spontaneous circulation (ROSC). The non-survival group was defined as cases who died within 1 month.
  
  
  RESULTS
  The plasma ADH and ACTH levels and the serum cortisol levels in both the surviving and the non-surviving patients were 82.3+/-74.5 and 149.6+/-135.4 (pg/ml), 239.7+/-327.4 and 282.4+/-553.0 (pg/ml), 34.1+/-11.2 and 19.0+/-12.8 (g/ml) (mean+/-S.D., respectively). The plasma ADH and ACTH levels showed no significant difference between the two groups. The serum cortisol levels were significantly higher in survivors than in the non-survivors (P=0.029). We also used the receiving-operating characteristics (ROC) curves to evaluate the optimal cutoff value of the concentration of serum cortisol as a predictive maker of non-surviving patients. The cutoff value of 16.7 g/ml for the concentrations of serum cortisol was a 1.00 positive predictive value and a 1.00 specificity at a 0.519 negative predictive and a 0.409 sensitivity for predicting non-surviving patients. The area under the ROC curve was calculated to be 0.858 at a prevalence of 0.58. The plasma ADH levels correlated significantly and positively with the plasma ACTH levels (r=0.516, P<0.0010).
  
  
  CONCLUSIONS
  We concluded that the serum cortisol levels were significantly higher in survivors than in non-survivors resuscitated after CPA.
authors.affiliation: Department of Traumatology and Critical Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan. grd1404@gr.ndmc.ac.jp
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Ito
authors.forename: Daizoh
authors.initials: D
authors.lastname: Saitoh
authors.forename: Akira
authors.initials: A
authors.lastname: Takasu
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kiyozumi
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Okada
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000368:Aged; D001127:Arginine Vasopressin / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D012372:ROC Curve; D012151:Resuscitation; D012680:Sensitivity and Specificity
chemical_list: D001127:Arginine Vasopressin; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone