[Relationship between the adrenal function and the prognosis of acute respiratory distress syndrome].
OBJECTIVE
To explore the relationship between the adrenal function and the prognosis of acute respiratory distress syndrome (ARDS).


METHODS
One hundred and fifty-eight patients with ARDS were enrolled in this study and were divided into two groups based on the prognosis: survival group and death group. Every patient was given one shot of corticotrophin 250 microg intravenously, plasma cortisol level was detected by radio-immunoassay before the shot (T0) and 30 minutes (T30) and 60 minutes (T60) after. And meanwhile the following parameters in the patients were recorded: age, APACH II, heart rate, mean arterial pressure, PaO(2)/FiO(2), arterial pH, hemoglobin, platelets and WBC, the number of failed organ and 28-day mortality. Relative adrenal insufficiency was defined as the difference between T0 and the highest value of T30 or T60 (DeltaTmax) <or= 248.4 nmol/L.


RESULTS
The total 28-day mortality was 54.4% (86/158) and the total incidence of relative adrenal insufficiency was 42.7% (68/158). The incidence of relative adrenal insufficiency in death group was significantly higher than that in survival group (62.8% vs 19.4%, P < 0.01). The 28-day mortality in patients complicated with relative adrenal insufficiency was significantly higher than that in those did not (76.5% vs 36.8%, P < 0.001). The area under the ROC curve for DeltaTmax was 0.655. With the multivariate analysis, the number of failed organ and relative adrenal insufficiency were independent risk factors of the death in patients with ARDS.


CONCLUSIONS
Adrenal function is valuable in predicting the prognosis of the ARDS.
Yang
Yi
Y
Department of Critical Care Medicine, Zhong-Da Hospital and School of Clinical Medcine, Southeast University, Nanjing 210009, China. yiyiyang2004@yahoo.com.cn
Liu
Ling
L
Zhao
Bo
B
Li
Mao-qin
MQ
Wu
Bin
B
Yan
Zheng
Z
Gu
Qin
Q
Sun
Hua
H
Qiu
Hai-bo
HB
D000293:Adolescent; D000311:Adrenal Glands / Q000503:physiopathology*; D000309:Adrenal Insufficiency / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000401:mortality / Q000503:physiopathology*