Clinical evaluation of hormonal stress state in medical ICU patients: a prospective blinded observational study.
OBJECTIVE
To evaluate whether classification of patients as having low, moderate, or high stress based on clinical parameters is associated with plasma levels of stress hormone.


METHODS
Prospective, blinded, observational study in an 18-bed medical ICU.


METHODS
Eighty-eight consecutive patients.


METHODS
Patients were classified as low (n=28), moderate (n=33) or high stress (n=27) on days 0 and 3 of ICU stay, based on 1 point for each abnormal parameter: body temperature, heart rate, systemic arterial pressure, respiratory rate, physical agitation, presence of infection and catecholamine administration. The stress categories were: high: 4 points or more, moderate 2-3 points, low 1 point. Plasma growth hormone (GH), insulin-like growth factor 1 (IGF-1), insulin, glucagon, cortisol were measured on days 0 and 3.


RESULTS
Plasma cortisol and glucagon were significantly higher and IGF-1 lower in high vs. low stress patients on days 0 and 3. High stress patients were more likely to have high cortisol levels (odds ratio 5.8, confidence interval 1.8-18.9), high glucagon (8.7, 2.1-36.1), and low IGF-1 levels (5.9, 1.8-19.0) than low stress patients on day 0. Moderate stress patients were also more likely to have high cortisol and glucagon levels than low stress patients. Insulin and GH did not differ significantly. Results were similar for day 3.


CONCLUSIONS
Moderate and severe stress was significantly associated with high catabolic (cortisol, glucagon) and low anabolic (IGF-1) hormone levels. The hormonal stress level in ICU patients can be estimated from simple clinical parameters during routine clinical evaluation.
Kyle
Ursula G
UG
Department of Nutrition, Geneva University Hospital, 1211, Geneva, Switzerland.
Jolliet
Philippe
P
Genton
Laurence
L
Meier
Christoph A
CA
Mensi
Nouri
N
Graf
Jean-Daniel
JD
Chevrolet
Jean-Claude
JC
Pichard
Claude
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D005260:Female; D005934:Glucagon / Q000097:blood; D013006:Growth Hormone / Q000097:blood; D006728:Hormones / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007328:Insulin / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D016037:Single-Blind Method; D013002:Somatomedins / Q000378:metabolism; D018709:Statistics, Nonparametric; D013312:Stress, Physiological / Q000097:blood / Q000145:classification / Q000175:diagnosis*
D006728:Hormones; D007328:Insulin; D013002:Somatomedins; D013006:Growth Hormone; D005934:Glucagon; D006854:Hydrocortisone