Changes Of Serum Cortisol In Patients With Respiratory Failure And Its Clinical Significance

Objective: To explore the level of serum COR in patients with respiratory failure and its changes with treatment,analyze the changes and evaluate its relationship with the severity of the disease.Provide reference for clinical assessment,treatment,and prognosis of patients with respiratory failure.Methods: We collected 60 medical records of respiratory failure patients who were admitted to the First Hospital of Shanxi Medical University from November 2016 to December 2017 and did not die during hospitalization.At the same time,60 patients without respiratory failure who were hospitalized for the same period of time were recruited as a case control group.Sixty healthy patients without endocrine diseases who were examined at the First Hospital of Shanxi Medical University were also collected as a healthy control group.The serum COR levels were measured in the healthy control group on the day of physical examination,the day after admission in the case control group,24 hours after admission in the respiratory failure group and 7 days after treatment,and the acute physiology and chronicity were calculated based on the worst value of physiological and biochemical indicators at the admission for 24 hours.The health grading system(actual physioiogy and chronic health evaluation scoring system,APACHE)II assesses the severity of illness in patients with respiratory failure.According to the APACHE II score,patients in the respiratory failure group were divided into 3 subgroups,20 in each group,namely: non-risk recombination,8?APACHEII score<16;risk reorganization,16?APACHEII score<20;extremely critical reorganization,APACHEII score?20 points.The levels of serum COR in the respiratory failure group and the case control group and the healthy control group were analyzed.The relationship between serum COR levels and disease severity in the three subgroups of the respiratory failure group was analyzed.And as the treatment progressed,the level of serum COR was changed;the correlation between APACHE II score and serum COR was analyzed;as well as the incidence of the relative adrenal insufficiency(RAI)were analyzed.Results: In the case-control group,serum cortisol was higher than the healthy control group,but the difference was not statistically significant.Serum cortisol was significantly higher in patients with respiratory failure than in healthy controls and case control patients,with a statistically significant difference.In the three subgroups of patients in the respiratory failure group,the higher the APACHEII score,the higher the cortisol level.The risk of COR in patients with compromised resuscitation was higher than that of non-risk recombination patients,and the difference was statistically significant.The COR level of critically ill recombinant patients was higher than that of non-risk recombination and critical recombination patients.The difference was statistically significant.After 7 days of non-risk reconstituted therapy,the COR level was higher than that at admission 24 hours,but the difference was not statistically significant(P>0.05).The level of COR decreased significantly after 7 days of threatening reorganization and extremely dangerous reorganization compared with 24 hours after admission.The difference was statistically significant(P<0.05).APACHEII score was positively correlated with serum COR(r=0.592,P<0.001).Using a randomized serum COR concentration of <10 ?g/dl(276 nmol/L)was used as the standard for diagnosing RAI,The incidence of RAI in respiratory failure patients was 18.3%.and a randomized serum COR concentration <25 ?g/dl(690 nmol/L)as the diagnostic criteria for RAI,the incidence of RAI in patients with respiratory failure was 73.3%.Conclusion: Serum COR levels in patients with respiratory failure were significantly higher than those in healthy individuals and those without respiratory failure,and were related to the severity of the disease and increased as the severity of the disease worsened.Serum COR levels can be a reliable indicator for assessing the condition of patients with respiratory failure.