Serum cortisol as a predictive marker of the outcome in patients resuscitated after cardiopulmonary arrest

Objects: To analyze the relationship between stress hormones (arginine vasopressin (ADH), adrenocorticotropic hormone (ACTH) and cortisol and the outcome of patients resuscitated after cardiopulmonary arrest (CPA). Methods: Thirty-six patients were enrolled in this study. In 36 of the resuscitated cases, 27 were non-survivors and 9 survived. The survival group was defined as cases either in a persistent vegetative state, with some disability or good recovery 1 month after return of spontaneous circulation (ROSC). The non-survival group was defined as cases who died within 1 month. Results: The plasma ADH and ACTH levels and the serum cortisol levels in both the surviving and the non-surviving patients were 82.3 +/- 74.5 and 149.6 +/- 135.4 (pg/ml), 239.7 +/- 327.4 and 282.4 +/- 553.0 (pg/ml), 34.1 +/- 11.2 and 19.0 +/- 12.8 (mug/ml) (mean +/- S.D., respectively). The plasma ADH and ACTH levels showed no significant difference between the two groups. The serum cortisol levels were significantly higher in survivors than in the non-survivors (P = 0.029). We also used the receiving-operating characteristics (ROC) curves to evaluate the optimal cutoff value of the concentration of serum cortisol as a predictive maker of non-surviving patients. The cutoff value of 16.7 mug/ml for the concentrations of serum cortisol was a 1.00 positive predictive value and a 1.00 specificity at a 0.519 negative predictive and a 0.409 sensitivity for predicting non-surviving patients. The area under the ROC curve was calculated to be 0.858 at a prevalence of 0.58. The plasma ADH levels correlated significantly and positively with the plasma ACTH levels (r = 0.516, P < 0.0010). Conclusions: We concluded that the serum cortisol levels were significantly higher in survivors than in non-survivors resuscitated after CPA. (C) 2004 Elsevier Ireland Ltd. All rights reserved.