title: Plasma cortisol levels in Guillain-Barré syndrome.
abstract: OBJECTIVE
  To assess the relationship between plasma cortisol level and Guillain-Barré syndrome-related complications, notably respiratory failure. One third of patients with Guillain-Barré syndrome develop respiratory failure, which is predicted by few early indicators. Adrenal function has rarely been studied in Guillain-Barré syndrome.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Intensive care unit in a teaching hospital.
  
  
  METHODS
  Patients with Guillain-Barré syndrome referred to our unit (n = 102).
  
  
  METHODS
  Plasma cortisol levels were measured before baseline and 60 mins after corticotrophin test in 93 patients with Guillain-Barré syndrome at admission, 16 (17%) of whom were ventilated within 24 hrs from admission, 17 (18%) ventilated after the 24th hr and 60 (65%) never ventilated.
  
  
  RESULTS
  Mean plasma cortisol levels at baseline and 60 mins after corticotrophin test were 22.9 +/- 11.3 ng/mL and 45.4 +/- 16.1 ng/mL. At baseline, the plasma cortisol levels were significantly higher in 17 (18%) patients, who developed respiratory failure at least 24 hrs later (28.5 +/- 12.1 ng/mL vs. 20.4 +/- 9.6 ng/mL; p = .003) and dysautonomia (33.1 +/- 14.3 ng/mL vs. 21.4 +/- 10.2 ng/mL, p = .003). When adjusting on only validated clinical predictors (i.e., delay between onset and admission <7 days, inability to lift head and vital capacity <60%), baseline cortisol level was the only independent risk factor for respiratory failure (odds ratio: 2.45 per 10 ng/mL [1.23-4.88 ng/mL], p = .01). Fifty-nine patients underwent electrophysiological testing. When adjusting on a validated electrophysiological model (i.e., peroneal proximal/distal compound muscle action potential ratio and vital capacity), baseline cortisol level remained an independent predictor (odds ratio: 2.50 per 10 ng/mL [1.14-5.51 ng/mL], p = .02).
  
  
  CONCLUSIONS
  Measurement of baseline plasma cortisol levels can be helpful for early detection of patients with Guillain-Barré syndrome at risk for respiratory failure at least 24 hrs later.
authors.affiliation: Medical Intensive Care Unit, Raymond Poincaré Teaching Hospital, Garches, France.
authors.forename: Julian
authors.initials: J
authors.lastname: Strauss
authors.forename: Jerome
authors.initials: J
authors.lastname: Aboab
authors.forename: Martin
authors.initials: M
authors.lastname: Rottmann
authors.forename: Raphael
authors.initials: R
authors.lastname: Porcher
authors.forename: Andrea
authors.initials: A
authors.lastname: Polito
authors.forename: Leon
authors.initials: L
authors.lastname: Ikka
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Durand
authors.forename: David
authors.initials: D
authors.lastname: Orlikowski
authors.forename: Christian
authors.initials: C
authors.lastname: Devaux
authors.forename: Frederic
authors.initials: F
authors.lastname: Lofaso
authors.forename: Djillali
authors.initials: D
authors.lastname: Annane
authors.forename: Jean-Luis
authors.initials: JL
authors.lastname: Gaillard
authors.forename: Tarek
authors.initials: T
authors.lastname: Sharshar
mesh_terms: D000304:Adrenal Cortex Function Tests; D000309:Adrenal Insufficiency / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D016207:Cytokines / Q000097:blood; D042241:Early Diagnosis; D005260:Female; D005602:France; D020275:Guillain-Barre Syndrome / Q000097:blood* / Q000150:complications; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007010:Hyponatremia / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D054969:Primary Dysautonomias / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D018805:Sepsis / Q000097:blood / Q000209:etiology / Q000517:prevention & control
chemical_list: D015415:Biomarkers; D016207:Cytokines; D006854:Hydrocortisone