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 ca re. Setting. Adult medical and coronary care units in a military refer ral hospital. Patients. A total of 61 consecutive patients requiring i ntensive care over a 5-month period and 20 control subjects. Intervent ions: Patients were evaluated within 24 hrs of ICU admission (day 1) w ith determination of the following variables: serum triiodothyronine, thyroxine, triiodothyronine resin uptake, thyrotropin, luteinizing hor mone, follicle-stimulating hormone, testosterone, basal cortisol, adre nocorticotropic hormone-stimulated cortisol, cortisol increment, and A cute Physiology and Chronic Health Evaluation (APACHE II) score. A tot al of 24 hrs later (day 2), the same battery of tests was repeated wit h the exception of the adrenocorticotropic hormone-stimulated cortisol , cortisol increment, and APACHE II score. Individual variables were c ompared between survivors and nonsurvivors. Measurements and Main Resu lts. The best discriminators of patient outcome in descending order we re the basal serum cortisol and triiodothyronine concentrations obtain ed on day 2 and the APACHE II score with predictive abilities of 81%, 74%, and 70%, respectively. No combination of variables was superior t o 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 a ppear to be better discriminators of patient outcome than the APACHE I I score.