Serum ACTH and Cortisol Level is Associated with the Acute Gastrointestinal Injury Grade in ICU Patients

Figures & data

Table 1 Characteristics of Patients and Baseline Information

Total Number	235
Age (years)	66(50,76)
Male (n)	137	58.30%
Charlson score	1(0,2)
Hypertension (n)	99	42.13%
Diabetes (n)	43	18.30%
BMI, kg/m^2	23.39(20.76,25.72)
Morbidity
Major surgery (n)	75	31.91%
Shock (n).	48	20.43%
Septic shock (n).	40	17.02%
Respiratory failure (n)	88	37.45%
Sepsis (n)	84	35.74%
Heart failure, no.	8	3.40%
AKI (n)	17	7.23%
AGI (n)	132	56.17%
APACHEII score	17(13,22)
SOFA score	5(2,8)
Cortisol, ug/dl	15.43(6.98,23.63)
ACTH, pg/mL	21.93(11.54,39.19)
CRP, mg/L	82(30,159)
PCT, pg/mL	0.92(0.3,3.4875)
Hospital stays, day	26(16,45)
ICU stay, day	10(4,21)
New onset infection in 14 days (n)	49	20.85%
28-ICU day death (n)	27	11.49%
Hospital death (n)	33	14.04%
ICU death (n)	25	10.64%

Abbreviations: APACHE, Acute Physiology and Chronic Health Evaluation; SOFA, Sequential Organ Failure Assessment; CRP, C-reactive protein; PCT, procalcitonin; AGI, Acute gastrointestinal injury; ACTH, adrenocorticotropic-hormone; AKI, Acute kidney injury; ICU, intensive care unit.

Table 2 Patient’s Characteristics for Survival in 28 Days

	Death	Survival	P
APACHE II score	22 (15, 28)	16 (13, 21)	0.01
Age	70 (58, 75)	65 (48, 76)	0.27
Charlson Index	2 (0, 3)	1 (0, 2)	0.03
SOFA score	11 (7,14)	4 (2, 7)	<0.01
AGI grade	2 (0,3)	1 (0,2)	0.03
Cortisol, ug/dl	24.43 (15.15, 38.62)	15.32 (9.63, 23.43)	<0.01
ACTH, pg/mL	33.04 (18.74, 61.40)	11.15 (11.15, 36.97)	0.01
CRP mg/L	117 (59,18)	80 (27,15)	0.04
PCT pg/mL	2.57 (0.96,20.26)	0.56 (0.01,1.95)	<0.01

Abbreviations: APACHE II, Acute Physiology and Chronic Health Evaluation; SOFA, Sequential Organ Failure Assessment; CRP, C-reactive protein; PCT, procalcitonin; AGI, Acute gastrointestinal injury; ACTH, adrenocorticotropic-hormone.

Table 3 Logistic Regression for 28-Day Mortality of the Patients

	OR	95% CI	P
Uni-variate
APACHE II	0.96	0.93–1.00	0.06
Charlson Index	0.77	0.56–1.01	0.06
SOFA score	0.78	0.71–0.86	<0.01
AGI grade	0.68	0.49–0.95	0.02
Cortisol, ug/dl	0.96	0.93–0.99	<0.01
ACTH, pg/mL	0.99	0.99–1.00	0.50
CRP, mg/L	0.99	0.99–1.00	0.07
PCT, pg/mL	0.98	0.97–0.99	0.01
Multivariate
SOFA score	0.80	0.72–0.89	<0.01
Cortisol, ug/dl	0.99	0.94–1.01	0.23
AGI grade	0.99	0.66–1.46	0.68
PCT, pg/mL	1.00	0.98–1.02	0.52

Abbreviations: APACHE II, Acute Physiology and Chronic Health Evaluation; SOFA, Sequential Organ Failure Assessment; CRP, C-reactive protein; PCT, procalcitonin; AGI, Acute gastrointestinal injury; ACTH, adrenocorticotropic-hormone; CI, confidence interval.

Table 4 (A) Correlation of Cortisol or ACTH and Other Parameters. (B) Correlation of AGI and Other Parameters, Unadjust. (C) Correlation of AGI Grade and Other Parameters, Adjusted

(A)
		Correlation		95% CI			P*
Cortisol
Age		0.01		(−0.12, 0.14)			0.8
Charlson Index		−0.50		(−0.18, 0.08)			0.45
APACHE II score		0.29		(0.16, 0.41)			<0.01
SOFA score		0.27		(0.15, 0.40)			<0.01
AGI grade		0.37		(0.251, 0.48)			<0.01
ACTH, pg/mL		0.24		(0.11, 0.36)			<0.01
CRP, mg/L		0.43		(0.32, 0.53)			<0.01
PCT, pg/mL		0.27		(0.15, 0.39)			<0.01
ACTH
Age		−0.27		(−0.16, 0.11)			0.68
Charlson Index		−0.13		(−0.26, 0.00)			0.04
APACHEII score		0.1		(0.01, 0.27)			0.03
SOFA score		0.15		(0.01, 0.27)			0.03
AGI grade		0.21		(0.08, 0.32)			<0.01
Cortisol, pg/mL		0.54		(0.44, 0.63)			<0.01
CRP, mg/L		0.21		(0.08, 0.33)			<0.01
PCT, pg/mL		0.18		(0.05, 0.30)			<0.01
(B)
	Non-AGI	AGI I	AGI II	AGI III	AGI IV	Correlation (95% CI)		P*
N	101	37	54	36	5
Age	65 (51,75)	71 (62,79)	62 (52,74)	57 (45,72)	68 (50,82)	0.25 (−0.19,0.70)		0.34
Charlson Index	1 (0,2)	1 (0,3)	1 (0,2)	0 (0,1)	1 (0,2)	0.14 (0.01, 0.26)		0.04
APACHEII score	15 (12,21)	15 (11,17.5)	18 (13,25)	19 (13,22)	22 (19,28)	0.176 (0.05,0.30)		<0.01
SOFA score	4 (2,7)	5 (3,7)	6 (2,11)	6 (2,11)	9 (7,11)	0.20 (0.07,0.32)		<0.01
Cortisol, ug/dl	11.65 (5.03,19.89)	14.77 (8.64,24.56)	19.41 (11.52,31.93)	20.72 (14.51,33.53)	33.24 (29.03,36.00)	0.31 (0.18,0.42)		<0.01
ACTH, pg/mL	18.05 (9.92,34.62)	21.56 (10.63,32.12)	24.49 (10.84,48.95)	30.53 (18.24,52.29)	32.92 (12.59,25.98)	0.21 (0.08,0.33)		<0.01
CRP, mg/L	51 (14,108)	70 (35,120)	99 (57,193)	143 (94,199)	184 (167,264)	0.37 (0.25, 0.48)		<0.01
PCT, pg/mL	0.27 (0.05, 1.40)	0.56 (0.22,0.75)	1.00 (0.51,3.06)	0.94 (0.37,0.94)	63.51 (42.54,79.23)	0.32 (0.20,0.43)		<0.01
(C)
			Correlation		(95% CI)			P^#
ACTH, pg/mL			0.05		0.01,0.58			0.04
Cortisol, ug/dl			0.03		0.01,0.26			0.03

Notes: *Spearman correlation analysis. ^#Partial correlation analysis.

Abbreviations: APACHE II, Acute Physiology and Chronic Health Evaluation; SOFA, Sequential Organ Failure Assessment; CRP, C-reactive protein; PCT, procalcitonin; AGI, Acute gastrointestinal injury; ACTH, adrenocorticotropic-hormone; CI, confidence interval.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author, Ming Zhong, upon reasonable request.