Correlation between Cosyntropin Stimulation Study and Disease Severity in Children with Fluid- and Catecholamine-Refractory Shock in the Pediatric and Cardiovascular Intensive Care Unit

Pallavi Iyer, Brittany Harrington, Jeffrey J. Fadrowski, Erica Sibinga, Ernest Amankwah

Research output: Contribution to journalArticle

Abstract

Background: The cosyntropin stimulation study (CSS) measures the patient’s ability to adequately mount a cortisol response. Clinically, CSS results may not be used to guide hydrocortisone use. The objective of this study was to examine how the CSS results are associated with clinical parameters, mortality/disease severity, and use of glucocorticoids in pediatric patients with catecholamine- and fluid-resistant shock. Methods: This was a retrospective cohort study of patients who had a CSS during 2009–2014 in the intensive care unit at a children’s hospital. Data collected included clinical variables, mortality, biochemical studies, and glucocorticoid use. PRISM III scores were used to determine the association between CSS results and disease severity. Adequate response to cosyntropin was defined as peak cortisol of 18 µg/dL or higher. Results: Of the 76 patients that underwent CSS, 68 (89%) had an adequate response to cosyntropin. There was a positive correlation between peak cortisol and PRISM III score (r = 0.45, r2 = 0.2). Glucocorticoid was administered in 52/76 (68%) despite several patients with normal CSS results. Conclusions: Sicker patients were more likely to have an adequate response to CSS. Clinically, glucocorticoid supplementation was not based on CSS results. Further prospective studies are needed to elucidate if CSS is a valuable clinical tool.

Original languageEnglish (US)
JournalHormone Research in Paediatrics
DOIs
StateAccepted/In press - Nov 17 2017

Fingerprint

Cosyntropin
Pediatric Intensive Care Units
Catecholamines
Shock
Glucocorticoids
Hydrocortisone
Mortality
Intensive Care Units

Keywords

  • Cortisol
  • Cosyntropin
  • Intensive care unit
  • Pediatric patients
  • Shock

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

@article{c723c96d73d04583b8c4bd670b8f08ef,
title = "Correlation between Cosyntropin Stimulation Study and Disease Severity in Children with Fluid- and Catecholamine-Refractory Shock in the Pediatric and Cardiovascular Intensive Care Unit",
abstract = "Background: The cosyntropin stimulation study (CSS) measures the patient’s ability to adequately mount a cortisol response. Clinically, CSS results may not be used to guide hydrocortisone use. The objective of this study was to examine how the CSS results are associated with clinical parameters, mortality/disease severity, and use of glucocorticoids in pediatric patients with catecholamine- and fluid-resistant shock. Methods: This was a retrospective cohort study of patients who had a CSS during 2009–2014 in the intensive care unit at a children’s hospital. Data collected included clinical variables, mortality, biochemical studies, and glucocorticoid use. PRISM III scores were used to determine the association between CSS results and disease severity. Adequate response to cosyntropin was defined as peak cortisol of 18 µg/dL or higher. Results: Of the 76 patients that underwent CSS, 68 (89{\%}) had an adequate response to cosyntropin. There was a positive correlation between peak cortisol and PRISM III score (r = 0.45, r2 = 0.2). Glucocorticoid was administered in 52/76 (68{\%}) despite several patients with normal CSS results. Conclusions: Sicker patients were more likely to have an adequate response to CSS. Clinically, glucocorticoid supplementation was not based on CSS results. Further prospective studies are needed to elucidate if CSS is a valuable clinical tool.",
keywords = "Cortisol, Cosyntropin, Intensive care unit, Pediatric patients, Shock",
author = "Pallavi Iyer and Brittany Harrington and Fadrowski, {Jeffrey J.} and Erica Sibinga and Ernest Amankwah",
year = "2017",
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language = "English (US)",
journal = "Hormone Research in Paediatrics",
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T1 - Correlation between Cosyntropin Stimulation Study and Disease Severity in Children with Fluid- and Catecholamine-Refractory Shock in the Pediatric and Cardiovascular Intensive Care Unit

AU - Iyer, Pallavi

AU - Harrington, Brittany

AU - Fadrowski, Jeffrey J.

AU - Sibinga, Erica

AU - Amankwah, Ernest

PY - 2017/11/17

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N2 - Background: The cosyntropin stimulation study (CSS) measures the patient’s ability to adequately mount a cortisol response. Clinically, CSS results may not be used to guide hydrocortisone use. The objective of this study was to examine how the CSS results are associated with clinical parameters, mortality/disease severity, and use of glucocorticoids in pediatric patients with catecholamine- and fluid-resistant shock. Methods: This was a retrospective cohort study of patients who had a CSS during 2009–2014 in the intensive care unit at a children’s hospital. Data collected included clinical variables, mortality, biochemical studies, and glucocorticoid use. PRISM III scores were used to determine the association between CSS results and disease severity. Adequate response to cosyntropin was defined as peak cortisol of 18 µg/dL or higher. Results: Of the 76 patients that underwent CSS, 68 (89%) had an adequate response to cosyntropin. There was a positive correlation between peak cortisol and PRISM III score (r = 0.45, r2 = 0.2). Glucocorticoid was administered in 52/76 (68%) despite several patients with normal CSS results. Conclusions: Sicker patients were more likely to have an adequate response to CSS. Clinically, glucocorticoid supplementation was not based on CSS results. Further prospective studies are needed to elucidate if CSS is a valuable clinical tool.

AB - Background: The cosyntropin stimulation study (CSS) measures the patient’s ability to adequately mount a cortisol response. Clinically, CSS results may not be used to guide hydrocortisone use. The objective of this study was to examine how the CSS results are associated with clinical parameters, mortality/disease severity, and use of glucocorticoids in pediatric patients with catecholamine- and fluid-resistant shock. Methods: This was a retrospective cohort study of patients who had a CSS during 2009–2014 in the intensive care unit at a children’s hospital. Data collected included clinical variables, mortality, biochemical studies, and glucocorticoid use. PRISM III scores were used to determine the association between CSS results and disease severity. Adequate response to cosyntropin was defined as peak cortisol of 18 µg/dL or higher. Results: Of the 76 patients that underwent CSS, 68 (89%) had an adequate response to cosyntropin. There was a positive correlation between peak cortisol and PRISM III score (r = 0.45, r2 = 0.2). Glucocorticoid was administered in 52/76 (68%) despite several patients with normal CSS results. Conclusions: Sicker patients were more likely to have an adequate response to CSS. Clinically, glucocorticoid supplementation was not based on CSS results. Further prospective studies are needed to elucidate if CSS is a valuable clinical tool.

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