BACKGROUND: The value of salivary cortisol measurement to study stress-related adrenal response is controversial. The study aim was to assess the role of salivary cortisol measurement to detect time-related changes of adrenal response in critically ill patients. PATIENTS AND METHODS: Patients with organ failure, sepsis or trauma were prospectively recruited in the Emergency Department. Serum and salivary cortisol were measured at baseline (T0) and after 48 h (T48). In 33 patients ACTH test was also done. RESULTS: Fifty-five patients were studied and classified as septic (22) or non-septic (33). We found a significant correlation between serum and salivary cortisol at T0 and T48. No patient had baseline serum cortisol < 276 nmol/L and salivary cortisol significantly decreased at T48 in almost all patients. A delta serum cortisol < 250 nmol/L after ACTH was found in only 4 patients who showed elevated baseline cortisol levels. CONCLUSION: We found that reduced baseline and post-ACTH cortisol levels are uncommon in our samples. In patients able to provide adequate saliva samples, salivary cortisol may be used to check the degree of stress-induced response and appears as a suitable tool for multiple measurements over time.

Determination of salivary cortisol to assess time related changes of the adrenal response to stress in critically ill patients

Puglisi S;PIZZUTO, ANDREA;Laface B;Panero F;Aprà F;Palmas E;Perotti P;Reimondo G;BOCCUZZI, ADRIANA;Terzolo M
Last
2019

Abstract

BACKGROUND: The value of salivary cortisol measurement to study stress-related adrenal response is controversial. The study aim was to assess the role of salivary cortisol measurement to detect time-related changes of adrenal response in critically ill patients. PATIENTS AND METHODS: Patients with organ failure, sepsis or trauma were prospectively recruited in the Emergency Department. Serum and salivary cortisol were measured at baseline (T0) and after 48 h (T48). In 33 patients ACTH test was also done. RESULTS: Fifty-five patients were studied and classified as septic (22) or non-septic (33). We found a significant correlation between serum and salivary cortisol at T0 and T48. No patient had baseline serum cortisol < 276 nmol/L and salivary cortisol significantly decreased at T48 in almost all patients. A delta serum cortisol < 250 nmol/L after ACTH was found in only 4 patients who showed elevated baseline cortisol levels. CONCLUSION: We found that reduced baseline and post-ACTH cortisol levels are uncommon in our samples. In patients able to provide adequate saliva samples, salivary cortisol may be used to check the degree of stress-induced response and appears as a suitable tool for multiple measurements over time.
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https://www.sciencedirect.com/science/article/pii/S0953620519302729?via=ihub
CIRCI; Critical illness; HPA axis; Salivary cortisol; Serum cortisol
Puglisi S, Pizzuto A, Laface B, Panero F, Aprà F, Palmas E, Perotti P, Reimondo G, Boccuzzi A, Terzolo M
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2318/1719506
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