Serum cytokines and critical illness-related corticosteroid insufficiency.
OBJECTIVE
Little information exists regarding the association of specific cytokine levels and different subgroups of patients with critical illness-related corticosteroid insufficiency (CIRCI).


METHODS
Data from a previous prospective study on adrenal function in the ICU were used in this study. CIRCI was diagnosed when either the basal cortisol was less than 10 μg/ml or the Δ cortisol was less than 9 μg/ml. The patients with CIRCI were further divided into a low basal cortisol (LBC) group (basal cortisol < 10 μg/ml), and low Δ cortisol (LDC) group (basal cortisol ≥ 10 μg/ml and Δ cortisol < 9 μg/ml). Serum cytokine levels were compared among the normal (NOM), LBC, and LDC groups.


RESULTS
The serum of 82 out of 123 (67%) patients included in the previous study was available for analysis; these patients were included in the present study. The overall incidence of CIRCI was 43.9% (36 out of 82 patients). Among patients with CIRCI, 16 (44.4%) were classified as the LBC group and 20 (55.6%) as the LDC group. The LDC group had significantly higher levels of IL-6 and IL-10 compared to both the NOM and LBC groups (p < 0.01). The LDC group also had significantly increased TNF-α (p = 0.002) compared to the LBC group. There were no significant differences in any of the cytokine levels between the NOM and LBC groups.


CONCLUSIONS
Elevated cytokines were associated with adrenal dysfunction in a subset of patients meeting the criteria for CIRCI (normal or high basal cortisol and low Δ cortisol).
Kwon
Yong Soo
YS
Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
Suh
Gee Young
GY
Jeon
Kyeongman
K
Park
So Young
SY
Lim
So Yeon
SY
Koh
Won-Jung
WJ
Chung
Man Pyo
MP
Kim
Hojoong
H
Kwon
O Jung
OJ
D000305:Adrenal Cortex Hormones / Q000172:deficiency*; D000368:Aged; D016638:Critical Illness; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D056910:Republic of Korea
D000305:Adrenal Cortex Hormones; D016207:Cytokines