title: Cortisol levels are influenced by sedation in the acute phase after subarachnoid haemorrhage.
abstract: BACKGROUND
  Subarachnoid haemorrhage (SAH) is a life-threatening condition that may be aggravated by acute pituitary damage and cortisol insufficiency. Robust diagnostic criteria for critical illness-related corticosteroid insufficiency (CIRCI) are lacking. The aim of this study was to assess the frequency of CIRCI in the acute phase (0-240 h) after SAH and to evaluate associations between cortisol levels and clinical parameters (sedation, circulatory failure, gender, age, severity of disease, treatment). CIRCI was defined as a single morning serum cortisol (mSC) < 200 nmol/L. The lower limit for calculated free cortisol (cFC) was set at < 22 nmol/L, and for saliva cortisol at < 7.7 nmol/L.
  
  
  METHODS
  Fifty patients were included. Serum/saliva cortisol and corticosteroid-binding globulin were obtained every second morning. A logistic regression model was used for multivariate analysis comparing cortisol levels with clinical parameters.
  
  
  RESULTS
  Of the patients, 21/50 (42%) had an mSC < 200 nmol/L and 30/50 (60%) had a cFC < 22 nmol/L. In patients with continuous intravenous sedation, the odds ratio for a mSC to be < 200 nmol/L was 18 times higher (95% confidence interval 4.2-85.0, P < 0.001), and the odds ratio for a cFC to be < 22 nmol/L was 2.4 times higher (95% confidence interval 1.2-4.7, P < 0.05) compared with patients with no continuous intravenous sedation.
  
  
  CONCLUSIONS
  Continuous intravenous sedation was significantly associated with cortisol values under defined limits (mSC < 200, cFC < 22 nmol/L). The possibility that sedating drugs per se may influence cortisol levels should be taken into consideration before CIRCI is diagnosed.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Institute of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden. cecilia.lindgren@anestesi.umu.se
authors.forename: C
authors.initials: C
authors.lastname: Lindgren
authors.forename: P
authors.initials: P
authors.lastname: Dahlqvist
authors.forename: P
authors.initials: P
authors.lastname: Lindvall
authors.forename: L
authors.initials: L
authors.lastname: Nilsson
authors.forename: L-O
authors.initials: LO
authors.lastname: Koskinen
authors.forename: S
authors.initials: S
authors.lastname: Naredi
mesh_terms: D000309:Adrenal Insufficiency / Q000097:blood*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000097:blood*; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012463:Saliva / Q000737:chemistry; D013345:Subarachnoid Hemorrhage / Q000097:blood*; D014156:Transcortin / Q000032:analysis
chemical_list: D006993:Hypnotics and Sedatives; D014156:Transcortin; D006854:Hydrocortisone