The DOI matches its Crossref record; 33 of the 33 references it cites were found in a registry or an index.
Diagnosis of Adrenal Insufficiency in Severe Sepsis and Septic Shock
Abstract
RATIONALE: Diagnosis of adrenal insufficiency in critically ill patients has relied on random or cosyntropin-stimulated cortisol levels, and has not been corroborated by a more accurate diagnostic standard. OBJECTIVE: We used the overnight metyrapone stimulation test to investigate the diagnostic value of the standard cosyntropin stimulation test, and the prevalence of sepsis-associated adrenal insufficiency. METHODS: This was an inception cohort study. MEASUREMENTS AND RESULTS: In two consecutive septic cohorts (n = 61 and n = 40), in 44 patients without sepsis and in 32 healthy volunteers, we measured (1) serum cortisol before and after cosyntropin stimulation, albumin, and corticosteroid-binding globulin levels, and (2) serum corticotropin, cortisol, and 11beta-deoxycortisol levels before and after an overnight metyrapone stimulation. Adrenal insufficiency was defined by postmetyrapone serum 11beta-deoxycortisol levels below 7 microg/dl. More patients with sepsis (31/61 [59% of original cohort with sepsis] and 24/40 [60% of validation cohort with sepsis]) met criteria for adrenal insufficiency than patients without sepsis (3/44; 7%) (p < 0.001 for both comparisons). Baseline cortisol (< 10 microg/dl), Delta cortisol (< 9 microg/dl), and free cortisol (< 2 microg/dl) had a positive likelihood ratio equal to infinity, 8.46 (95% confidence interval, 1.19-60.25), and 9.50 (95% confidence interval, 1.05-9.54), respectively. The best predictor of adrenal insufficiency (as defined by metyrapone testing) was baseline cortisol of 10 microg/dl or less or Delta cortisol of less than 9 microg/dl. The best predictors of normal adrenal response were cosyntropin-stimulated cortisol of 44 microg/dl or greater and Delta cortisol of 16.8 microg/dl or greater. CONCLUSIONS: In sepsis, adrenal insufficiency is likely when baseline cortisol levels are less than 10 microg/dl or delta cortisol is less than 9 microg/dl, and unlikely when cosyntropin-stimulated cortisol level is 44 microg/dl or greater or Delta cortisol is 16.8 microg/dl or greater.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Altered ACTH synthesis in response to metyrapone was observed in roughly half of patients with septic shock and very occasionally in critically ill patients without sepsis [64].”
In the citing paper
“As noted earlier, about half of patients with septic shock have decreased cortisol synthesis as assessed by response to the metyrapone test [64].”
In the citing paper
“Compared with healthy volunteers, clinical studies have found ACTH levels to be significantly lower in critically ill septic patients [14,64,65].”
Citations
Cites
Bone, R. C., BALK, R. A., Cerra, F. B., Dellinger, R. P., Fein, A. M., Knaus, W. A., Schein, R. M. H., & Sibbald, W. J. (1992) · CHEST Journal · doi:10.1378/chest.101.6.1644 · Cited by 13,335
Vincent, J. L., Moreno, R., Takala, J., Willatts, S., De Mendonça, A., Bruining, H., Reinhart, C. K., Suter, P. M., & Thijs, L. G. (1996) · Intensive Care Medicine · doi:10.1007/bf01709751 · Cited by 11,674
Intensive insulin therapy in critically ill patients.
Van den Berghe, G., Wouters, P., Weekers, F., Verwaest, C., Bruyninckx, F., Schetz, M., Vlasselaers, D., Ferdinande, P., Lauwers, P., & Bouillon, R. (2001) · New England Journal of Medicine · doi:10.1056/nejmoa011300 · Cited by 9,977
Le Gall, J.-R. (1993) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.270.24.2957 · Cited by 7,773
American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference
(1992) · Critical Care Medicine · doi:10.1097/00003246-199206000-00025 · Cited by 5,134
Intensive insulin therapy in the medical ICU
Van den Berghe, G., Wilmer, A., Hermans, G., Meersseman, W., Wouters, P. J., Milants, I., Van Wijngaerden, E., Bobbaers, H., & Bouillon, R. (2006) · New England Journal of Medicine · doi:10.1056/nejmoa052521 · Cited by 3,639
Annane, D. (2002) · JAMA · doi:10.1001/jama.288.7.862 · Cited by 3,075
Self-citationMcCabe, W. R. (1962) · Archives of Internal Medicine · doi:10.1001/archinte.1962.03620240029006 · Cited by 1,378
Kreger, B. E., Craven, D. E., & McCabe, W. R. (1980) · The American Journal of Medicine · doi:10.1016/0002-9343(80)90102-3 · Cited by 1,314
Corticosteroid insufficiency in acutely ill patients
Cooper, M. S., & Stewart, P. M. (2003) · New England Journal of Medicine · doi:10.1056/nejmra020529 · Cited by 1,033
Research works printed but not linked: 3
- 1911, Lancet, 1, 577
- 1996, J Clin Endocrinol Metab, 81, 285
- 1993, JAMA, 270, 2957, 10.1001/jama.1993.03510240069035 · DOI · Paper page
Cited by
Sorted by citations
Marik, P. E., Pastores, S. M., Annane, D., Meduri, G. U., Sprung, C. L., Arlt, W., Keh, D., Briegel, J., Beishuizen, A., Dimopoulou, I., et al. (2008) · Critical Care Medicine · doi:10.1097/ccm.0b013e31817603ba · Cited by 912
Self-citationDavis, A. L., Carcillo, J. A., Aneja, R. K., Deymann, A. J., Lin, J. C., Nguyen, T. C., Okhuysen‐Cawley, R., Relvas, M. S., Rozenfeld, R. A., Skippen, P. W., et al. (2017) · Critical Care Medicine · doi:10.1097/ccm.0000000000002425 · Cited by 689
Sepsis: Multiple Abnormalities, Heterogeneous Responses, and Evolving Understanding
Iskander, K. N., Osuchowski, M. F., Stearns-Kurosawa, D. J., Kurosawa, S., Stepien, D. M., Valentine, C., & Remick, D. G. (2013) · Physiological Reviews · doi:10.1152/physrev.00037.2012 · Cited by 470
Critical Illness-Related Corticosteroid Insufficiency
Marik, P. E. (2009) · Chest · doi:10.1378/chest.08-1149 · Cited by 299
Christ-Crain, M., Stolz, D., Jutla, S., Couppis, O., Müller, C., Bingisser, R., Schuetz, P., Tamm, M., Edwards, R., Müller, B., et al. (2007) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200702-307oc · Cited by 134
Metadata
- Authors
- Annane, D., Maxime, V., Ibrahim, F., Alvarez, J. C., Abe, E., & Boudou, P.
- Affiliations
- Hôpital Lariboisière (FR)
- Service de Réanimation and Service de Biochimie-Pharmacologie, Hôpital Raymond Poincaré, Faculté de Médecine Paris Ile de France Ouest, Garches; and Service de Biochimie Hormonale, Hôpital Saint Louis, Faculté de Médecine Saint Louis Lariboisière, Paris, France
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-12
- Volume
- 174
- Issue
- 12
- Pages
- 1319-1326
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W2007130516
- Cited by
- 327
- References
- 33
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 8 · 2023: 11 · 2022: 4 · 2021: 8 · 2020: 13 · 2019: 13 · 2018: 6 · 2017: 13 · 2016: 13 · 2015: 19 · 2014: 20 · 2013: 19 · 2012: 25
- FWCI
- 20.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Keywords
- adrenal insufficiency, sepsis, septic shock, ACTH stimulation test, cortisol, ACTH, diagnostic criteria, critically ill patients, likelihood ratios, corticosteroid-binding globulin, albumin, free cortisol, 11beta-hydroxylase deficiency, ACTH deficiency
- MeSH terms
- Adrenal Insufficiency, Adrenocorticotropic Hormone, Aged, Cosyntropin, Female, Humans, Hydrocortisone, Male, Metyrapone, Middle Aged, Serum Albumin, Shock, Septic, Transcortin, Sepsis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
