Profiling endogenous adrenal function during veno-venous ECMO support in COVID-19 ARDS: a descriptive analysis
BackgroundProlonged 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 insufficienc...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-01-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2023.1321511/full |
| _version_ | 1797346339366895616 |
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| author | Clemens Baumgartner Peter Wolf Alexander Hermann Sebastian König Mathias Maleczek Mathias Maleczek Daniel Laxar Daniel Laxar Marko Poglitsch Oliver Domenig Katharina Krenn Judith Schiefer Alexandra Kautzky-Willer Michael Krebs Martina Hermann Martina Hermann |
| author_facet | Clemens Baumgartner Peter Wolf Alexander Hermann Sebastian König Mathias Maleczek Mathias Maleczek Daniel Laxar Daniel Laxar Marko Poglitsch Oliver Domenig Katharina Krenn Judith Schiefer Alexandra Kautzky-Willer Michael Krebs Martina Hermann Martina Hermann |
| author_sort | Clemens Baumgartner |
| collection | DOAJ |
| description | BackgroundProlonged 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.MethodsA 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.ResultsCortisol 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.ConclusionOxygenation 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. |
| first_indexed | 2024-03-08T11:31:57Z |
| format | Article |
| id | doaj.art-052972c23dce40f59d65171fbad95cfe |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-03-08T11:31:57Z |
| publishDate | 2024-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-052972c23dce40f59d65171fbad95cfe2024-01-25T17:05:00ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922024-01-011410.3389/fendo.2023.13215111321511Profiling endogenous adrenal function during veno-venous ECMO support in COVID-19 ARDS: a descriptive analysisClemens Baumgartner0Peter Wolf1Alexander Hermann2Sebastian König3Mathias Maleczek4Mathias Maleczek5Daniel Laxar6Daniel Laxar7Marko Poglitsch8Oliver Domenig9Katharina Krenn10Judith Schiefer11Alexandra Kautzky-Willer12Michael Krebs13Martina Hermann14Martina Hermann15Department of Internal Medicine III, Medical University of Vienna, Vienna, AustriaDepartment of Internal Medicine III, Medical University of Vienna, Vienna, AustriaDepartment of Internal Medicine I, Medical University of Vienna, Vienna, AustriaDepartment of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, AustriaDepartment of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, AustriaLudwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, AustriaDepartment of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, AustriaLudwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, AustriaAttoquant Diagnostics, Vienna, AustriaAttoquant Diagnostics, Vienna, AustriaDepartment of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, AustriaDepartment of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, AustriaDepartment of Internal Medicine III, Medical University of Vienna, Vienna, AustriaDepartment of Internal Medicine III, Medical University of Vienna, Vienna, AustriaDepartment of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, AustriaLudwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, AustriaBackgroundProlonged 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.MethodsA 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.ResultsCortisol 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.ConclusionOxygenation 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.https://www.frontiersin.org/articles/10.3389/fendo.2023.1321511/fullcortisolcritical illness related corticosteroid insufficiencyextracorporeal membrane oxygenationacute respiratory distress syndromesevere coronavirus disease 2019 |
| spellingShingle | Clemens Baumgartner Peter Wolf Alexander Hermann Sebastian König Mathias Maleczek Mathias Maleczek Daniel Laxar Daniel Laxar Marko Poglitsch Oliver Domenig Katharina Krenn Judith Schiefer Alexandra Kautzky-Willer Michael Krebs Martina Hermann Martina Hermann Profiling endogenous adrenal function during veno-venous ECMO support in COVID-19 ARDS: a descriptive analysis Frontiers in Endocrinology cortisol critical illness related corticosteroid insufficiency extracorporeal membrane oxygenation acute respiratory distress syndrome severe coronavirus disease 2019 |
| title | Profiling endogenous adrenal function during veno-venous ECMO support in COVID-19 ARDS: a descriptive analysis |
| title_full | Profiling endogenous adrenal function during veno-venous ECMO support in COVID-19 ARDS: a descriptive analysis |
| title_fullStr | Profiling endogenous adrenal function during veno-venous ECMO support in COVID-19 ARDS: a descriptive analysis |
| title_full_unstemmed | Profiling endogenous adrenal function during veno-venous ECMO support in COVID-19 ARDS: a descriptive analysis |
| title_short | Profiling endogenous adrenal function during veno-venous ECMO support in COVID-19 ARDS: a descriptive analysis |
| title_sort | profiling endogenous adrenal function during veno venous ecmo support in covid 19 ards a descriptive analysis |
| topic | cortisol critical illness related corticosteroid insufficiency extracorporeal membrane oxygenation acute respiratory distress syndrome severe coronavirus disease 2019 |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2023.1321511/full |
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