Plasma cortisol levels in Guillain-Barré syndrome.

Abstract

OBJECTIVE:

To assess the relationship between plasma cortisol level and Guillain-Barré syndrome-related complications, notably respiratory failure. One third of patients with Guillain-Barré syndrome develop respiratory failure, which is predicted by few early indicators. Adrenal function has rarely been studied in Guillain-Barré syndrome.

DESIGN:

Prospective study.

SETTING:

Intensive care unit in a teaching hospital.

PATIENTS:

Patients with Guillain-Barré syndrome referred to our unit (n = 102).

INTERVENTIONS:

Plasma cortisol levels were measured before baseline and 60 mins after corticotrophin test in 93 patients with Guillain-Barré syndrome at admission, 16 (17%) of whom were ventilated within 24 hrs from admission, 17 (18%) ventilated after the 24th hr and 60 (65%) never ventilated.

MEASUREMENTS AND MAIN RESULTS:

Mean plasma cortisol levels at baseline and 60 mins after corticotrophin test were 22.9 +/- 11.3 ng/mL and 45.4 +/- 16.1 ng/mL. At baseline, the plasma cortisol levels were significantly higher in 17 (18%) patients, who developed respiratory failure at least 24 hrs later (28.5 +/- 12.1 ng/mL vs. 20.4 +/- 9.6 ng/mL; p = .003) and dysautonomia (33.1 +/- 14.3 ng/mL vs. 21.4 +/- 10.2 ng/mL, p = .003). When adjusting on only validated clinical predictors (i.e., delay between onset and admission <7 days, inability to lift head and vital capacity <60%), baseline cortisol level was the only independent risk factor for respiratory failure (odds ratio: 2.45 per 10 ng/mL [1.23-4.88 ng/mL], p = .01). Fifty-nine patients underwent electrophysiological testing. When adjusting on a validated electrophysiological model (i.e., peroneal proximal/distal compound muscle action potential ratio and vital capacity), baseline cortisol level remained an independent predictor (odds ratio: 2.50 per 10 ng/mL [1.14-5.51 ng/mL], p = .02).

CONCLUSION:

Measurement of baseline plasma cortisol levels can be helpful for early detection of patients with Guillain-Barré syndrome at risk for respiratory failure at least 24 hrs later.

• Authors: Julian Strauss, Jerome Aboab, Martin Rottmann, Raphael Porcher, Andrea Polito, Leon Ikka, Marie-Christine Durand, David Orlikowski, Christian Devaux, Frederic Lofaso, Djillali Annane, Jean-Luis Gaillard, Tarek Sharshar
• Journal: Critical care medicine (Crit Care Med) Vol. 37 Issue 8 Pg. 2436-40 (Aug 2009) ISSN: 1530-0293 [Electronic] United States
• PMID: 19531948 (Publication Type: Journal Article)

Chemical References

• Biomarkers
• Cytokines
• Hydrocortisone

Topics

• Adrenal Cortex Function Tests
• Adrenal Insufficiency (blood, diagnosis, etiology)
• Biomarkers (blood)
• Cytokines (blood)
• Early Diagnosis
• Female
• France
• Guillain-Barre Syndrome (blood, complications)
• Humans
• Hydrocortisone (blood)
• Hyponatremia (blood, etiology, prevention & control)
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Predictive Value of Tests
• Primary Dysautonomias (blood, etiology, prevention & control)
• Prospective Studies
• Respiratory Insufficiency (blood, etiology, prevention & control)
• Sepsis (blood, etiology, prevention & control)