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：95

作者：

Annane, Djillali ^{[1
]}

Pastores, Stephen M. ^{[2
]}

Arlt, Wiebke ^{[4
,5
]}

Balk, Robert A. ^{[6
]}

Beishuizen, Albertus ^{[7
]}

Briegel, Josef ^{[8
]}

Carcillo, Joseph ^{[9
]}

Christ-Crain, Mirjam ^{[10
]}

Cooper, Mark S. ^{[11
]}

Marik, Paul E. ^{[12
]}

Meduri, Gianfranco Umberto ^{[13
]}

Olsen, Keith M. ^{[14
]}

Rochwerg, Bram ^{[3
]}

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

Russell, James A. ^{[17
]}

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

机构：

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

[2] Mem Sloan Kettering Canc Ctr, Dept Anesthesiol & Crit Care Med, 1275 York Ave,C-1179, New York, NY 10065 USA

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[18] KU Leuven Univ & Hosp, Clin Div, B-3000 Louvain, Belgium

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

来源：

INTENSIVE CARE MEDICINE | 2017年 / 43卷 / 12期

关键词：

Corticosteroid insufficiency; Critical illness; Sepsis; Glucocorticoids; Glucocorticoid receptor; TUMOR-NECROSIS-FACTOR; 11-BETA-HYDROXYSTEROID DEHYDROGENASE TYPE-1; GLUCOCORTICOID-RECEPTOR EXPRESSION; RESPIRATORY-DISTRESS-SYNDROME; PITUITARY-ADRENAL AXIS; NITRIC-OXIDE SYNTHASE; GENE-EXPRESSION; SEPTIC SHOCK; INFLAMMATORY CYTOKINES; SYSTEMIC INFLAMMATION;

D O I：

10.1007/s00134-017-4914-x

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

To provide a narrative review of the latest concepts and understanding of the pathophysiology of critical illness-related corticosteroid insufficiency (CIRCI). A multispecialty task force of international experts in critical care medicine and endocrinology and members of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM). Medline, Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews. 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. 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：1781 / 1792

页数：12

共 85 条

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