Abstract P42: Decreasing Cortisol Levels in the First Day Following Cardiac Arrest May Be Associated With the Development of Multi-System Organ Failure
Introduction: The post cardiac arrest syndrome has been likened to sepsis. It has been proposed that adrenal suppression may result. We measured serum cortisol levels in patients resuscitated from cardiac arrest to determine cortisol levels during the initial phase of post-resuscitation care and if changes in cortisol levels correlate with development of multi-system organ failure (MSOF) or survival.
Methods: Subjects were prospectively enrolled and had blood samples were drawn at hospital arrival and 24 hours after cardiac arrest. Age, gender, location of arrest, development of MSOF, defined as failure in 3 or more organ systems, survival and good outcome, defined as discharge home or acute rehabilitation facility. Either the patient or their proxy provided consent. Sera were banked at −70°C until analysis. Enzyme linked immunoassay analysis for cortisol was completed on all subjects. Comparison between initial, 24 hour, and delta cortisol levels were completed based on MSOF and survival via one-sided t-test.
Results: Thirty subjects were enrolled in the study. The mean age was 60±15 years, 19 (63%) were male, 18 (60%) suffered out of hospital cardiac arrest, and 14 (47%) were due to ventricular dysrhythmia. Six patients (20%) developed multi system organ failure during hospitalization. Overall, 15 (50%) survived and 12 (40%) had a good outcome. Mean arrival cortisol level was not different between survivors and non-survivors (631±56ng/mL vs. 631±55ng/mL, p=.5). Mean 24-hour cortisol was also not different between survivors and non-survivors (571±46ng/mL vs. 658±54ng/mL, p=.11). Non-survivors tended to have a decrease in cortisol during the first 24 hours (−26±37ng/mL vs. 59±41ng/mL, p=.07). Mean initial cortisol levels tended to be lower in subjects that later developed MSOF (519±120ng/mL vs. 659±38ng/mL, p=.07). Cortisol levels at 24 hours were not different between the MSOF and non-MSOF cohorts (586±110ng/mL vs. 622±37ng/mL, p=.35). Subjects who developed MSOF tended to have a decrease in cortisol during the first 24 hours (−66±79ng/mL vs. 37±29ng/mL, p=.07).
Conclusions: Cortisol levels are elevated after cardiac arrest. A decreasing cortisol level at 24 hours may predict the development of MSOF and death.