title: Glucocorticoid Receptor Expression in Peripheral WBCs of Critically Ill Children.
abstract: OBJECTIVE
  To characterize glucocorticoid receptor expression in peripheral WBCs of critically ill children using flow cytometry.
  
  
  METHODS
  Prospective observational cohort.
  
  
  METHODS
  A university-affiliated, tertiary PICU.
  
  
  METHODS
  Fifty-two critically ill children.
  
  
  METHODS
  Samples collected for measurement of glucocorticoid receptor expression and parallel cortisol levels.
  
  
  RESULTS
  Subjects with cardiovascular failure had significantly lower glucocorticoid receptor expression both in CD4 lymphocytes (mean fluorescence intensity, 522 [354-787] vs 830 [511-1,219]; p = 0.036) and CD8 lymphocytes (mean fluorescence intensity, 686 [350-835] vs 946 [558-1,511]; p = 0.019) compared with subjects without cardiovascular failure. Subjects in the upper 50th percentile of Pediatric Risk of Mortality III scores and organ failure also had significantly lower glucocorticoid receptor expression in CD4 and CD8 lymphocytes. There was no linear correlation between cortisol concentrations and glucocorticoid receptor expression.
  
  
  CONCLUSIONS
  Our study suggests that patients with shock and increased severity of illness have lower glucocorticoid receptor expression in CD4 and CD8 lymphocytes. Glucocorticoid receptor expression does not correlate well with cortisol levels. Future studies could focus on studying glucocorticoid receptor expression variability and isoform distribution in the pediatric critically ill population as well as on different strategies to optimize glucocorticoid response.
authors: 1Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Israelita Albert Einstein, Sao Paulo, Brazil. 2Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Hospital Research Foundation, Cincinnati, OH.
authors: Audrey R Ogawa
authors: AR
authors: Shibata
authors: Eduardo J
authors: EJ
authors: Troster
authors: Hector R
authors: HR
authors: Wong
mesh_terms: D000293:Adolescent; D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism; D018414:CD8-Positive T-Lymphocytes / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D005434:Flow Cytometry; D006785:Hospitals, University; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D063305:Organ Dysfunction Scores; D011446:Prospective Studies; D011965:Receptors, Glucocorticoid / Q000096:biosynthesis*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood / Q000401:mortality
chemical_list: D011965:Receptors, Glucocorticoid; D006854:Hydrocortisone