Interstitial cortisol obtained by microdialysis in mechanically ventilated septic patients: Correlations with total and free serum cortisol

Dimitra Argyro Vassiliadi; Ioannis Ilias; Marinella Tzanela; Nikitas Nikitas; Maria Theodorakopoulou; Petros Kopterides; Nikolaos Maniatis; Argyris Diamantakis; Stylianos E. Orfanos; Ilias Perogamvros; Apostolos Armaganidis; Brian G. Keevil; Stylianos Tsagarakis; Ioanna Dimopoulou

doi:10.1016/j.jcrc.2012.07.008

Interstitial cortisol obtained by microdialysis in mechanically ventilated septic patients: Correlations with total and free serum cortisol

Dimitra Argyro Vassiliadi^*
, Ioannis Ilias
, Marinella Tzanela
, Nikitas Nikitas
, Maria Theodorakopoulou
, Petros Kopterides
, Nikolaos Maniatis
, Argyris Diamantakis
, Stylianos E. Orfanos
, Ilias Perogamvros
, Apostolos Armaganidis
, Brian G. Keevil
, Stylianos Tsagarakis
, Ioanna Dimopoulou

^*Corresponding author for this work

Attikon University Hospital
E. Venizelou Hospital
Evagelismos Hospital
Manchester University NHS Foundation Trust

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose: The aim of this study was to measure subcutaneous tissue cortisol obtained by microdialysis (MD) in 35 mechanically ventilated septic patients. Materials and Methods: Upon intensive care unit admission, an MD catheter was inserted into the subcutaneous tissue of the thigh. Cortisol (CORT) was determined in a 5:00 to 9:00 am microdialysate sample collected within 72 hours. Concurrently, serum total (T-CORT) and free CORT (F-CORT) were measured. The Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment scores were calculated. Both T-CORT less than 10 μg/dL and F-CORT less than 0.8 μg/dL were considered as indicating critical illness-related corticosteroid insufficiency. Adrenal adequacy was defined as T-CORT greater than 20 μg/dL or F-CORT greater than 2.0 μg/dL. Results: Total CORT correlated significantly with F-CORT (r_s = +0.8, P < .0001). Microdialysis CORT had a lower correlation with T-CORT (r_s = +0.6, P < .0001) and F-CORT (r_s = +0.7, P < .0001) and a weak correlation with APACHE II score (r_s = +0.4, P < .01). On the basis of MD-CORT, the patients were divided in quartiles. Although the median F-CORT and T-CORT levels were significantly different (P < .001) among the MD-CORT quartiles, there was a considerable overlap between the subgroups. All patients with T-CORT less than 10 μg/dL and all but 3 patients with F-CORT less than 0.8 μg/dL had tissue CORT in the lower quartile. However, only 50% and 58% of patients with adequate T-CORT and F-CORT levels, respectively, had concordant MD-CORT in the highest quartile. Conclusions: Microdialysis CORT levels correlate moderately with circulating T-CORT and F-CORT. Of note, several patients presented with discrepant measurements between interstitial and circulating CORT concentrations. Thus, interstitial CORT measurements represent an additional tool to investigate the tissue CORT availability in critically ill patients.

Original language	English
Pages (from-to)	158-165
Number of pages	8
Journal	Journal of Critical Care
Volume	28
Issue number	2
DOIs	https://doi.org/10.1016/j.jcrc.2012.07.008
Publication status	Published - Apr 2013
Externally published	Yes

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine

Keywords

Cortisol
Critical care
Microdialysis
Sepsis
Septic shock
Systemic inflammatory response syndrome

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10.1016/j.jcrc.2012.07.008

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Vassiliadi, D. A., Ilias, I., Tzanela, M., Nikitas, N., Theodorakopoulou, M., Kopterides, P., Maniatis, N., Diamantakis, A., Orfanos, S. E., Perogamvros, I., Armaganidis, A., Keevil, B. G., Tsagarakis, S., & Dimopoulou, I. (2013). Interstitial cortisol obtained by microdialysis in mechanically ventilated septic patients: Correlations with total and free serum cortisol. Journal of Critical Care, 28(2), 158-165. https://doi.org/10.1016/j.jcrc.2012.07.008

@article{0294dd76f8504cddb722eeb6fc5ea432,

title = "Interstitial cortisol obtained by microdialysis in mechanically ventilated septic patients: Correlations with total and free serum cortisol",

abstract = "Purpose: The aim of this study was to measure subcutaneous tissue cortisol obtained by microdialysis (MD) in 35 mechanically ventilated septic patients. Materials and Methods: Upon intensive care unit admission, an MD catheter was inserted into the subcutaneous tissue of the thigh. Cortisol (CORT) was determined in a 5:00 to 9:00 am microdialysate sample collected within 72 hours. Concurrently, serum total (T-CORT) and free CORT (F-CORT) were measured. The Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment scores were calculated. Both T-CORT less than 10 μg/dL and F-CORT less than 0.8 μg/dL were considered as indicating critical illness-related corticosteroid insufficiency. Adrenal adequacy was defined as T-CORT greater than 20 μg/dL or F-CORT greater than 2.0 μg/dL. Results: Total CORT correlated significantly with F-CORT (rs = +0.8, P < .0001). Microdialysis CORT had a lower correlation with T-CORT (rs = +0.6, P < .0001) and F-CORT (rs = +0.7, P < .0001) and a weak correlation with APACHE II score (rs = +0.4, P < .01). On the basis of MD-CORT, the patients were divided in quartiles. Although the median F-CORT and T-CORT levels were significantly different (P < .001) among the MD-CORT quartiles, there was a considerable overlap between the subgroups. All patients with T-CORT less than 10 μg/dL and all but 3 patients with F-CORT less than 0.8 μg/dL had tissue CORT in the lower quartile. However, only 50\% and 58\% of patients with adequate T-CORT and F-CORT levels, respectively, had concordant MD-CORT in the highest quartile. Conclusions: Microdialysis CORT levels correlate moderately with circulating T-CORT and F-CORT. Of note, several patients presented with discrepant measurements between interstitial and circulating CORT concentrations. Thus, interstitial CORT measurements represent an additional tool to investigate the tissue CORT availability in critically ill patients.",

keywords = "Cortisol, Critical care, Microdialysis, Sepsis, Septic shock, Systemic inflammatory response syndrome",

author = "Vassiliadi, \{Dimitra Argyro\} and Ioannis Ilias and Marinella Tzanela and Nikitas Nikitas and Maria Theodorakopoulou and Petros Kopterides and Nikolaos Maniatis and Argyris Diamantakis and Orfanos, \{Stylianos E.\} and Ilias Perogamvros and Apostolos Armaganidis and Keevil, \{Brian G.\} and Stylianos Tsagarakis and Ioanna Dimopoulou",

year = "2013",

month = apr,

doi = "10.1016/j.jcrc.2012.07.008",

language = "English",

volume = "28",

pages = "158--165",

journal = "Journal of Critical Care",

issn = "0883-9441",

publisher = "W.B. Saunders",

number = "2",

}

Vassiliadi, DA, Ilias, I, Tzanela, M, Nikitas, N, Theodorakopoulou, M, Kopterides, P, Maniatis, N, Diamantakis, A, Orfanos, SE, Perogamvros, I, Armaganidis, A, Keevil, BG, Tsagarakis, S & Dimopoulou, I 2013, 'Interstitial cortisol obtained by microdialysis in mechanically ventilated septic patients: Correlations with total and free serum cortisol', Journal of Critical Care, vol. 28, no. 2, pp. 158-165. https://doi.org/10.1016/j.jcrc.2012.07.008

TY - JOUR

T1 - Interstitial cortisol obtained by microdialysis in mechanically ventilated septic patients

T2 - Correlations with total and free serum cortisol

AU - Vassiliadi, Dimitra Argyro

AU - Ilias, Ioannis

AU - Tzanela, Marinella

AU - Nikitas, Nikitas

AU - Theodorakopoulou, Maria

AU - Kopterides, Petros

AU - Maniatis, Nikolaos

AU - Diamantakis, Argyris

AU - Orfanos, Stylianos E.

AU - Perogamvros, Ilias

AU - Armaganidis, Apostolos

AU - Keevil, Brian G.

AU - Tsagarakis, Stylianos

AU - Dimopoulou, Ioanna

PY - 2013/4

Y1 - 2013/4

N2 - Purpose: The aim of this study was to measure subcutaneous tissue cortisol obtained by microdialysis (MD) in 35 mechanically ventilated septic patients. Materials and Methods: Upon intensive care unit admission, an MD catheter was inserted into the subcutaneous tissue of the thigh. Cortisol (CORT) was determined in a 5:00 to 9:00 am microdialysate sample collected within 72 hours. Concurrently, serum total (T-CORT) and free CORT (F-CORT) were measured. The Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment scores were calculated. Both T-CORT less than 10 μg/dL and F-CORT less than 0.8 μg/dL were considered as indicating critical illness-related corticosteroid insufficiency. Adrenal adequacy was defined as T-CORT greater than 20 μg/dL or F-CORT greater than 2.0 μg/dL. Results: Total CORT correlated significantly with F-CORT (rs = +0.8, P < .0001). Microdialysis CORT had a lower correlation with T-CORT (rs = +0.6, P < .0001) and F-CORT (rs = +0.7, P < .0001) and a weak correlation with APACHE II score (rs = +0.4, P < .01). On the basis of MD-CORT, the patients were divided in quartiles. Although the median F-CORT and T-CORT levels were significantly different (P < .001) among the MD-CORT quartiles, there was a considerable overlap between the subgroups. All patients with T-CORT less than 10 μg/dL and all but 3 patients with F-CORT less than 0.8 μg/dL had tissue CORT in the lower quartile. However, only 50% and 58% of patients with adequate T-CORT and F-CORT levels, respectively, had concordant MD-CORT in the highest quartile. Conclusions: Microdialysis CORT levels correlate moderately with circulating T-CORT and F-CORT. Of note, several patients presented with discrepant measurements between interstitial and circulating CORT concentrations. Thus, interstitial CORT measurements represent an additional tool to investigate the tissue CORT availability in critically ill patients.

AB - Purpose: The aim of this study was to measure subcutaneous tissue cortisol obtained by microdialysis (MD) in 35 mechanically ventilated septic patients. Materials and Methods: Upon intensive care unit admission, an MD catheter was inserted into the subcutaneous tissue of the thigh. Cortisol (CORT) was determined in a 5:00 to 9:00 am microdialysate sample collected within 72 hours. Concurrently, serum total (T-CORT) and free CORT (F-CORT) were measured. The Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment scores were calculated. Both T-CORT less than 10 μg/dL and F-CORT less than 0.8 μg/dL were considered as indicating critical illness-related corticosteroid insufficiency. Adrenal adequacy was defined as T-CORT greater than 20 μg/dL or F-CORT greater than 2.0 μg/dL. Results: Total CORT correlated significantly with F-CORT (rs = +0.8, P < .0001). Microdialysis CORT had a lower correlation with T-CORT (rs = +0.6, P < .0001) and F-CORT (rs = +0.7, P < .0001) and a weak correlation with APACHE II score (rs = +0.4, P < .01). On the basis of MD-CORT, the patients were divided in quartiles. Although the median F-CORT and T-CORT levels were significantly different (P < .001) among the MD-CORT quartiles, there was a considerable overlap between the subgroups. All patients with T-CORT less than 10 μg/dL and all but 3 patients with F-CORT less than 0.8 μg/dL had tissue CORT in the lower quartile. However, only 50% and 58% of patients with adequate T-CORT and F-CORT levels, respectively, had concordant MD-CORT in the highest quartile. Conclusions: Microdialysis CORT levels correlate moderately with circulating T-CORT and F-CORT. Of note, several patients presented with discrepant measurements between interstitial and circulating CORT concentrations. Thus, interstitial CORT measurements represent an additional tool to investigate the tissue CORT availability in critically ill patients.

KW - Cortisol

KW - Critical care

KW - Microdialysis

KW - Sepsis

KW - Septic shock

KW - Systemic inflammatory response syndrome

UR - https://www.scopus.com/pages/publications/84875403060

U2 - 10.1016/j.jcrc.2012.07.008

DO - 10.1016/j.jcrc.2012.07.008

M3 - Article

C2 - 22981531

AN - SCOPUS:84875403060

SN - 0883-9441

VL - 28

SP - 158

EP - 165

JO - Journal of Critical Care

JF - Journal of Critical Care

IS - 2

ER -

Interstitial cortisol obtained by microdialysis in mechanically ventilated septic patients: Correlations with total and free serum cortisol

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ASJC Scopus subject areas

Keywords

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