Abstract | BACKGROUND: After brain death, adrenal insufficiency (AI) is very common and may be one of the mechanisms that contributes to hemodynamic instability and loss of potential organ donors. However, when diagnosed by total cortisol measurement, critically ill patients may be overdiagnosed as having AI. The aims of this study were to assess the prevalence of AI when diagnosed using free cortisol measurement and the accuracy of total cortisol measurement to diagnose AI in brain-dead patients. METHODS: RESULTS: Among the 42 included patients, the incidence of AI was 83% (95% CI, 69-93%). Baseline total cortisol was correlated with baseline free cortisol, whatever the albumin or corticosteroid-binding globulin concentration. The area under the receiver operating characteristic curve of baseline total cortisol measurement to diagnose AI was 0.94 (95% CI, 0.81-0.98). The optimal cutoff was 485 nM(-1), providing a sensitivity and a specificity of 89% and 100%, respectively. CONCLUSION:
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Authors | Armelle Nicolas-Robin, Jérome D Barouk, Elsa Darnal, Bruno Riou, Olivier Langeron |
Journal | Anesthesiology
(Anesthesiology)
Vol. 115
Issue 3
Pg. 568-74
(Sep 2011)
ISSN: 1528-1175 [Electronic] United States |
PMID | 21795963
(Publication Type: Journal Article)
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Chemical References |
- Serum Albumin
- Adrenocorticotropic Hormone
- Transcortin
- Hydrocortisone
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Topics |
- Adrenal Insufficiency
(blood, diagnosis)
- Adrenocorticotropic Hormone
(blood)
- Adult
- Aged
- Area Under Curve
- Brain Death
(diagnosis)
- Female
- Humans
- Hydrocortisone
(blood)
- Male
- Middle Aged
- Organ Transplantation
- ROC Curve
- Serum Albumin
(analysis)
- Transcortin
(analysis)
- Young Adult
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