Profiling endogenous adrenal function during veno-venous ECMO support in COVID-19 ARDS : a descriptive analysis
Copyright © 2024 Baumgartner, Wolf, Hermann, König, Maleczek, Laxar, Poglitsch, Domenig, Krenn, Schiefer, Kautzky-Willer, Krebs and Hermann..
Background: Prolonged critical illness is often accompanied by an impairment of adrenal function, which has been frequently related to conditions complicating patient management. The presumed connection between hypoxia and the pathogenesis of this critical- illness- related corticosteroid insufficiency (CIRCI) might play an important role in patients with severe acute respiratory distress syndrome (ARDS). Since extracorporeal membrane oxygenation (ECMO) is frequently used in ARDS, but data on CIRCI during this condition are scarce, this study reports the behaviour of adrenal function parameters during oxygenation support with veno-venous (vv)ECMO in coronavirus disease 2019 (COVID-19) ARDS.
Methods: A total of 11 patients undergoing vvECMO due to COVID-19 ARDS at the Medical University of Vienna, who received no concurrent corticosteroid therapy, were retrospectively included in this study. We analysed the concentrations of cortisol, aldosterone, and angiotensin (Ang) metabolites (Ang I-IV, Ang 1-7, and Ang 1-5) in serum via liquid chromatography/tandem mass spectrometry before, after 1 day, 1 week, and 2 weeks during vvECMO support and conducted correlation analyses between cortisol and parameters of disease severity.
Results: Cortisol concentrations appeared to be lowest after initiation of ECMO and progressively increased throughout the study period. Higher concentrations were related to disease severity and correlated markedly with interleukin-6, procalcitonin, pH, base excess, and albumin during the first day of ECMO. Fair correlations during the first day could be observed with calcium, duration of critical illness, and ECMO gas flow. Angiotensin metabolite concentrations were available in a subset of patients and indicated a more homogenous aldosterone response to plasma renin activity after 1 week of ECMO support.
Conclusion: Oxygenation support through vvECMO may lead to a partial recovery of adrenal function over time. In homogenous patient collectives, this novel approach might help to further determine the importance of adrenal stress response in ECMO and the influence of oxygenation support on CIRCI.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:14 |
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| Enthalten in: |
Frontiers in endocrinology - 14(2023) vom: 01., Seite 1321511 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Baumgartner, Clemens [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 14.02.2024 Date Revised 06.03.2024 published: Electronic-eCollection Citation Status MEDLINE |
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| doi: |
10.3389/fendo.2023.1321511 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM368232204 |
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| 100 | 1 | |a Baumgartner, Clemens |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Profiling endogenous adrenal function during veno-venous ECMO support in COVID-19 ARDS |b a descriptive analysis |
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| 500 | |a Date Revised 06.03.2024 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2024 Baumgartner, Wolf, Hermann, König, Maleczek, Laxar, Poglitsch, Domenig, Krenn, Schiefer, Kautzky-Willer, Krebs and Hermann. | ||
| 520 | |a Background: Prolonged critical illness is often accompanied by an impairment of adrenal function, which has been frequently related to conditions complicating patient management. The presumed connection between hypoxia and the pathogenesis of this critical- illness- related corticosteroid insufficiency (CIRCI) might play an important role in patients with severe acute respiratory distress syndrome (ARDS). Since extracorporeal membrane oxygenation (ECMO) is frequently used in ARDS, but data on CIRCI during this condition are scarce, this study reports the behaviour of adrenal function parameters during oxygenation support with veno-venous (vv)ECMO in coronavirus disease 2019 (COVID-19) ARDS | ||
| 520 | |a Methods: A total of 11 patients undergoing vvECMO due to COVID-19 ARDS at the Medical University of Vienna, who received no concurrent corticosteroid therapy, were retrospectively included in this study. We analysed the concentrations of cortisol, aldosterone, and angiotensin (Ang) metabolites (Ang I-IV, Ang 1-7, and Ang 1-5) in serum via liquid chromatography/tandem mass spectrometry before, after 1 day, 1 week, and 2 weeks during vvECMO support and conducted correlation analyses between cortisol and parameters of disease severity | ||
| 520 | |a Results: Cortisol concentrations appeared to be lowest after initiation of ECMO and progressively increased throughout the study period. Higher concentrations were related to disease severity and correlated markedly with interleukin-6, procalcitonin, pH, base excess, and albumin during the first day of ECMO. Fair correlations during the first day could be observed with calcium, duration of critical illness, and ECMO gas flow. Angiotensin metabolite concentrations were available in a subset of patients and indicated a more homogenous aldosterone response to plasma renin activity after 1 week of ECMO support | ||
| 520 | |a Conclusion: Oxygenation support through vvECMO may lead to a partial recovery of adrenal function over time. In homogenous patient collectives, this novel approach might help to further determine the importance of adrenal stress response in ECMO and the influence of oxygenation support on CIRCI | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a acute respiratory distress syndrome | |
| 650 | 4 | |a cortisol | |
| 650 | 4 | |a critical illness related corticosteroid insufficiency | |
| 650 | 4 | |a extracorporeal membrane oxygenation | |
| 650 | 4 | |a severe coronavirus disease 2019 | |
| 650 | 7 | |a Hydrocortisone |2 NLM | |
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| 650 | 7 | |a Aldosterone |2 NLM | |
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| 700 | 1 | |a Wolf, Peter |e verfasserin |4 aut | |
| 700 | 1 | |a Hermann, Alexander |e verfasserin |4 aut | |
| 700 | 1 | |a König, Sebastian |e verfasserin |4 aut | |
| 700 | 1 | |a Maleczek, Mathias |e verfasserin |4 aut | |
| 700 | 1 | |a Laxar, Daniel |e verfasserin |4 aut | |
| 700 | 1 | |a Poglitsch, Marko |e verfasserin |4 aut | |
| 700 | 1 | |a Domenig, Oliver |e verfasserin |4 aut | |
| 700 | 1 | |a Krenn, Katharina |e verfasserin |4 aut | |
| 700 | 1 | |a Schiefer, Judith |e verfasserin |4 aut | |
| 700 | 1 | |a Kautzky-Willer, Alexandra |e verfasserin |4 aut | |
| 700 | 1 | |a Krebs, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Hermann, Martina |e verfasserin |4 aut | |
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