Prognostic value of cortisol and thyroid function tests in poisoned patients admitted to toxicology ICU

作     者：Shahin Shadnia Nasim Zamani Hossein Hassanian-Moghaddam Hamed Shafaroodi Mina Padandar Mohammad Hasan Rezaeizadeh 

作者机构：Toxicological Research CenterDepartment of Clinical ToxicologyLoghman Hakim HospitalShahid Beheshti University of Medical Sciences Excellence Center of Clinical ToxicologyIranian Ministry of Health Pharmaceutical Sciences BranchIslamic Azad University(IAUPS) 

出 版 物：《World Journal of Emergency Medicine》 (世界急诊医学杂志（英文）)

年 卷 期：2018年第9卷第1期

页      面：51-55页

核心收录：

学科分类：0401[教育学-教育学] 04[教育学] 1002[医学-临床医学] 040110[教育学-教育技术学（可授教育学、理学学位）] 

主　　题：Prognosis Intensive care unit Cortisol Thyroid function tests Poisoning 

摘      要：BACKGROUND: Prognostic value of cortisol and thyroid function tests(TFTs) has previously been evaluated in medical ICUs. We aimed to evaluate prognostic efficacy of cortisol and TFTs in critically ill poisoned patients admitted to toxicology intensive care unit(ICU).METHODS: In a prospective study of consecutively enrolled subjects admitted to the toxicology ICU, lab analyses included TFTs(total T3 and T4 as well as TSH) and cortisol levels drawn between 8 am–10 am during period of the first 24 hours post-ingestion/exposure. Simplified Acute Physiology Score Ⅱ(SAPS Ⅱ) and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) were recorded. All scores were compared to detect the best prognostic factor. Type of poisoning was also ***: In 200 patients evaluated, 129 were male and mean age was 31 years. In general, SAPS Ⅱ, T4, and cortisol could prognosticate death. After regression analysis, only cortisol had such efficacy(P=0.04; OR=1.06; 95%CI=1.05–1.08; cut-off=42 μg/d L; sensitivity=70%; specificity=82%). Between aluminium phosphide(ALP)-and non ALP-poisoned patients, level of consciousness, mean arterial pressure, and cortisol level could prognosticate death in ALP poisoning(all Ps0.001 in both uni and multivariate analyses). Median(interquartile range; IQR) GCS was 7(6, 10) and 15(8, 15) in non-ALP and ALP-poisoned patients(P0.003). SAPS Ⅱ and APACHE Ⅱ could not prognosticate death at ***: Cortisol best prognosticated outcomes for subjects admitted to the toxicology ICU. Its level is higher in ALP-poisoned patients probably due to the higher stress while they remain conscious till the final stages of toxicity and are aware of deterioration of their clinical condition or may be due to their significantly lower blood pressures.