Cortisol levels are influenced by sedation in the acute phase after subarachnoid haemorrhage

• Published in: Acta anaesthesiologica Scandinavica Vol. 57; no. 4; pp. 452 - 460
• Main Authors: LINDGREN, C., DAHLQVIST, P., LINDVALL, P., NILSSON, L., KOSKINEN, L.-O., NAREDI, S.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.04.2013; Wiley Subscription Services, Inc
• Subjects: Adrenal Insufficiency - blood; Adult; Aged; Aged, 80 and over; Confidence intervals; Critical Illness; Female; Humans; Hydrocortisone - analysis; Hydrocortisone - blood; Hypnotics and Sedatives - pharmacology; Logistic Models; Male; Middle Aged; Multivariate analysis; Saliva - chemistry; Subarachnoid Hemorrhage - blood; Transcortin - analysis
• ISSN: 0001-5172; 1399-6576; 1399-6576
• DOI: 10.1111/aas.12014

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.