Critical Illness-Related Corticosteroid Insufficiency (CIRCI): A Narrative Review from a Multispecialty Task Force of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM)

被引：91

作者：

Annane, Djillali ^{[1
]}

Pastores, Stephen M. ^{[2
]}

Arlt, Wiebke ^{[3
,4
]}

Balk, Robert A. ^{[5
]}

Beishuizen, Albertus ^{[6
]}

Briegel, Josef ^{[7
]}

Carcillo, Joseph ^{[8
]}

Christ-Crain, Mirjam ^{[9
]}

Cooper, Mark S. ^{[10
]}

Marik, Paul E. ^{[11
]}

Meduri, Gianfranco Umberto ^{[12
]}

Olsen, Keith M. ^{[13
]}

Rochwerg, Bram ^{[14
]}

Rodgers, Sophia C. ^{[15
,16
]}

Russell, James A. ^{[17
]}

Van den Berghe, Greet ^{[18
,19
]}

机构：

[1] Univ Versailles SQY Paris Saclay, Raymond Poincare Hosp, AP HP, Gen ICU Dept,Hlth Sci Ctr Simone Veil, Garches, France

[2] Mem Sloan Kettering Canc Ctr, Dept Anesthesiol & Crit Care Med, New York, NY 10021 USA

[3] Univ Birmingham, IMSR, Birmingham, W Midlands, England

[4] Birmingham Hlth Partners, Ctr Endocrinol Diabet & Metab CEDAM, Birmingham, W Midlands, England

[5] Rush Univ, Med Ctr, Div Pulm & Crit Care Med, Chicago, IL 60612 USA

[6] Med Spectrum Twente, Dept Intens Care Med, Enschede, Netherlands

[7] Klinikum Univ, Klin Anasthesiol, Anesthesiol & Crit Care Med, Munich, Germany

[8] Univ Pittsburgh, Sch Med, Dept Crit Care Med & Pediat, Pittsburgh, PA USA

[9] Univ Hosp Basel, Dept Endocrinol Diabetol & Metab, Dept Clin Res, Basel, Switzerland

[10] Univ Sydney, Concord Hosp, Dept Endocrinol, Sydney, NSW, Australia

[11] Eastern Virginia Med Sch, Div Pulm & Crit Care Med, Norfolk, VA 23501 USA

[12] Memphis Vet Affairs Med Ctr, Dept Med, Div Pulm Crit Care & Sleep Med, Memphis, TN USA

[13] Univ Arkansas Med Sci, Coll Pharm, Little Rock, AR 72205 USA

[14] McMaster Univ, Div Crit Care, Dept Med, Hamilton, ON, Canada

[15] Univ New Mexico, Clin Adjunct Fac, Albuquerque, NM 87131 USA

[16] Sandoval Reg Med Ctr, Albuquerque, NM USA

[17] Univ British Columbia, St Pauls Hosp, Div Crit Care Med, Ctr Heart Lung Innovat, Vancouver, BC, Canada

[18] KU Leuven Univ & Hosp, Clin Div, Dept Cellular & Mol Med, B-3000 Leuven, Belgium

[19] KU Leuven Univ & Hosp, Lab Intens Care Med, Dept Cellular & Mol Med, B-3000 Leuven, Belgium

来源：

CRITICAL CARE MEDICINE | 2017年 / 45卷 / 12期

关键词：

Corticosteroid insufficiency; critical illness; sepsis; glucocorticoids; glucocorticoid receptor; RESPIRATORY-DISTRESS-SYNDROME; TUMOR-NECROSIS-FACTOR; 11-BETA-HYDROXYSTEROID DEHYDROGENASE TYPE-1; GLUCOCORTICOID-RECEPTOR-ALPHA; PITUITARY-ADRENAL AXIS; NITRIC-OXIDE SYNTHASE; SEPTIC SHOCK; SYSTEMIC INFLAMMATION; GENE-EXPRESSION; PERSISTENT ELEVATION;

D O I：

10.1097/CCM.0000000000002724

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objective: To provide a narrative review of the latest concepts and understanding of the pathophysiology of critical illness-related corticosteroid insufficiency (CIRCI). Participants: A multi-specialty task force of international experts in critical care medicine and endocrinology and members of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. Data Sources: Medline, Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews. Results: Three major pathophysiologic events were considered to constitute CIRCI: dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, altered cortisol metabolism, and tissue resistance to glucocorticoids. The dysregulation of the HPA axis is complex, involving multidirectional crosstalk between the CRH/ACTH pathways, autonomic nervous system, vasopressinergic system, and immune system. Recent studies have demonstrated that plasma clearance of cortisol is markedly reduced during critical illness, explained by suppressed expression and activity of the primary cortisol-metabolizing enzymes in the liver and kidney. Despite the elevated cortisol levels during critical illness, tissue resistance to glucocorticoids is believed to occur due to insufficient glucocorticoid alpha-mediated anti-inflammatory activity. Conclusions: Novel insights into the pathophysiology of CIRCI add to the limitations of the current diagnostic tools to identify at-risk patients and may also impact how corticosteroids are used in patients with CIRCI.

引用

页码：2089 / 2098

页数：10

共 85 条

[1] Plasma cytokines IL-6, IL-8, and IL-10 are associated with the development of acute respiratory distress syndrome in patients with severe traumatic brain injury
Aisiku, Imo P.
Yamal, Jose-Miguel
Doshi, Pratik
Benoit, Julia S.
Gopinath, Shankar
Goodman, Jerry C.
Robertson, Claudia S.
[J]. CRITICAL CARE, 2016, 20
[2] Diagnosis of adrenal insufficiency in severe sepsis and septic shock
Annane, Djillali
Maxime, Virginie
Ibrahim, Fidaa
Alvarez, Jean Claude
Abe, Emuri
Boudou, Philippe
[J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2006, 174 (12) : 1319 - 1326
[3] Predictive value of nuclear factor κB activity and plasma cytokine levels in patients with sepsis
Arnalich, F
Garcia-Palomero, E
López, J
Jiménez, M
Madero, R
Renart, J
Vazquez, JJ
Montiel, C
[J]. INFECTION AND IMMUNITY, 2000, 68 (04) : 1942 - 1945
[4] Patterns of corticosteroid-binding globulin and the free cortisol index during septic shock and multitrauma
Beishuizen, A
Thijs, LG
Vermes, I
[J]. INTENSIVE CARE MEDICINE, 2001, 27 (10) : 1584 - 1591
[5] Impairment of neutrophilic glucocorticoid receptor function in patients treated with steroids for septic shock
Bergquist M.
Lindholm C.
Strinnholm M.
Hedenstierna G.
Rylander C.
[J]. Intensive Care Medicine Experimental, 3 (1)
[6] Expression of the glucocorticoid receptor is decreased in experimental Staphylococcus aureus sepsis
Bergquist, Maria
Nurkkala, Merja
Rylander, Christian
Kristiansson, Erik
Hedenstierna, Goran
Lindholm, Catharina
[J]. JOURNAL OF INFECTION, 2013, 67 (06) : 574 - 583
[7] IMMUNOREGULATORY FEEDBACK BETWEEN INTERLEUKIN-1 AND GLUCOCORTICOID HORMONES
BESEDOVSKY, H
DELREY, A
SORKIN, E
DINARELLO, CA
[J]. SCIENCE, 1986, 233 (4764) : 652 - 654
[8] New insights into the controversy of adrenal function during critical illness
Boonen, Eva
Bornstein, Stefan R.
Van den Berghe, Greet
[J]. LANCET DIABETES & ENDOCRINOLOGY, 2015, 3 (10) : 805 - 815
[9] Endocrine Responses to Critical Illness: Novel Insights and Therapeutic Implications
Boonen, Eva
Van den Berghe, Greet
[J]. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2014, 99 (05) : 1569 - 1582
[10] Reduced nocturnal ACTH-driven cortisol secretion during critical illness
Boonen, Eva
Meersseman, Philippe
Vervenne, Hilke
Meyfroidt, Geert
Guiza, Fabian
Wouters, Pieter J.
Veldhuis, Johannes D.
Van den Berghe, Greet
[J]. AMERICAN JOURNAL OF PHYSIOLOGY-ENDOCRINOLOGY AND METABOLISM, 2014, 306 (08): : E883 - E892

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