ENDOCRINE PROFILES FOR OUTCOME PREDICTION FROM THE INTENSIVE-CARE UNIT

Objective. To evaluate the discriminating ability of various specific endocrine studies on patient outcome from the intensive care unit (ICU). Design: Prospective cohort study of patients requiring intensive care. Setting. Adult medical and coronary care units in a military referral hospital. Patients. A total of 61 consecutive patients requiring intensive care over a 5-month period and 20 control subjects. Interventions: Patients were evaluated within 24 hrs of ICU admission (day 1) with determination of the following variables: serum triiodothyronine, thyroxine, triiodothyronine resin uptake, thyrotropin, luteinizing hormone, follicle-stimulating hormone, testosterone, basal cortisol, adrenocorticotropic hormone-stimulated cortisol, cortisol increment, and Acute Physiology and Chronic Health Evaluation (APACHE II) score. A total of 24 hrs later (day 2), the same battery of tests was repeated with the exception of the adrenocorticotropic hormone-stimulated cortisol, cortisol increment, and APACHE II score. Individual variables were compared between survivors and nonsurvivors. Measurements and Main Results. The best discriminators of patient outcome in descending order were the basal serum cortisol and triiodothyronine concentrations obtained on day 2 and the APACHE II score with predictive abilities of 81%, 74%, and 70%, respectively. No combination of variables was superior to the day 2 basal cortisol concentration for discrimination of outcome. Conclusions: The basal cortisol and triiodothyronine concentrations obtained from blood samples collected within 48 hrs of ICU admission appear to be better discriminators of patient outcome than the APACHE II score.