# The effect of serum cortisol level on the outcomes of Persistent Inflammation, Immunosuppression and Catabolism Syndrome patients in the intensive care unit

## TL;DR

This study examined how serum cortisol levels in ICU patients with PIICS relate to clinical outcomes and found that cortisol levels decrease over time, especially in older patients with higher SOFA scores.

## Contribution

The study provides new insights into the temporal changes of cortisol levels in PIICS patients and their association with clinical indicators like SOFA scores.

## Key findings

- Cortisol levels at T3 were significantly lower than at T2.
- SOFA scores were significantly higher at T3 compared to earlier time points.
- Low cortisol at T3 was associated with significantly higher mean age.

## Abstract

This study sought to elucidate the potential association between serum cortisol level and clinical outcomes in patients diagnosed with Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PIICS).

This prospective observational study, initiated in January 2023 and concluded in July 2023 enrolled 42 patients diagnosed with PIICS admitted to the intensive care unit (ICU) at Training and Research Hospital. For the purpose of analysis, serum cortisol levels were categorized as low (<15 μg/dL) and high (>15 μdL). To facilitate data organization and subsequent analysis, measurements were categorized into three time intervals following ICU admission: T1 (days 14-21), T2 (days 21-28), and T3 (days >28). Statistical analysis was performed using IBM-SPSS 28. A significance level of p < 0.05 was set to determine statistically significant differences between groups.

Cortisol measured at T3 were significantly lower (p < 0.05) compared to T2. In contrast, SOFA scores were significantly higher (p < 0.05). No statistically significant differences were observed between the low and high cortisol level groups at T1, T2 and T3 in terms of gender, APACHE-2 score, SOFA score, ICU length of stay (days), duration of mechanical ventilation (days), mortality rate, or mechanical ventilation requirement at discharge. Patients in the low cortisol group at T3 exhibited a significantly higher mean age compared to those in the high cortisol group (p < 0.05).

Cortisol levels in ICU patients may change over time. That cortisol levels tend to decrease as the length of stay increases, in older patients, and in PIICS patients with elevated SOFA scores.