Stress hormones and posttraumatic stress symptoms following paediatric critical illness: an exploratory study
Tóm tắt
In this exploratory case–control study, we investigated basal cortisol regulation in 5–16-year-old children, 3–6 months following PICU (paediatric intensive care) admission. This was nested within a study of child psychological and cognitive function; 47 children were assessed alongside 56 healthy controls. Saliva samples were collected three times per day (immediately after waking, waking +30 min, and waking +12 h) over two consecutive weekdays. In addition, data on posttraumatic stress symptoms were ascertained from 33 PICU admitted children using the Impact of Events Scale-8 (IES-8). Primary analysis revealed no significant differences in basal cortisol concentrations between PICU discharged children and healthy controls (p > 0.05). Secondary analysis in the PICU group identified a significant positive association between posttraumatic stress symptoms and evening (waking +12 h) cortisol concentrations (p = 0.004). However, when subject to multivariate analysis, evening cortisol was a modest independent predictor of IES-8 scores, relative to the presence of septic illness and poor pre-morbid health. We conclude that paediatric critical illness does not appear to result in marked perturbations to basal cortisol at 3–6 month following discharge. There was evidence of a link between evening cortisol and symptoms of PTSD, but this was not a robust effect and requires further elucidation.
Tài liệu tham khảo
Davydow DS, Gifford JM, Desai SV, Needham DM, Bienvenu OJ (2008) Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatry 30:421–434. doi:10.1016/j.genhosppsych.2008.05.006
Als L, Picouto MD, Hau SM, Nadel S, Cooper M, Pierce CM, Kramer T, Garralda ME (2015) Mental and physical well-being following admission to paediatric intensive care. Pediatr Crit Care Med 16:e141–e149. doi:10.1097/PCC.0000000000000424
Diaz-Caneja A, Gledhill J, Weaver T, Nadel S, Garralda E (2005) A child’s admission to hospital: a qualitative study examining the experiences of parents. Intensive Care Med 31:1248–1254
Goodman S, Sprung CL, Ziegler D, Weiss YG (2005) Cortisol changes among patients with septic shock and the relationship to ICU and hospital stay. Intensive Care Med 31:1362–1369
Boonen E, Vervenne H, Meersseman P et al (2013) Reduced cortisol metabolism during critical illness. N Engl J Med 368:1477–1488. doi:10.1056/NEJMoa1214969
Joosten K, De Kleijn E, Westerterp M, De Hoog M, Eijck F, Hop W (2000) Endocrine and metabolic responses in children with meningoccocal sepsis: striking differences between survivors and nonsurvivors. J Clin Endocrinol Metab 85:3746–3753
Riordan FAI, Thomson APJ, Ratcliffe JM, Sills JA, Diver MJ, Hart CA (1999) Admission cortisol and adrenocorticotrophic hormone levels in children with meningococcal disease: evidence of adrenal insufficiency? Crit Care Med 27:2257–2261
den Brinker M, Joosten K, Liem O, de Jong F, Hop WCJ, Hazelzet JA, van Dijk M, Hokken-Koelega ACS (2005) Adrenal insufficiency in meningococcal sepsis: bioavailable cortisol levels and impact of interleukin-6 levels and intubation with etomidate on adrenal function and mortality. J Clin Endocrinol Metab 90:5110–5117
Küçükemre Aydin B, Demirkol D, Bas F et al (2014) Evaluation of endocrine function in children admitted to pediatric intensive care unit. Pediatr Int 56:349–353
Mennon K, Clarkson C (2002) Adrenal function in pediatric critical illness. Pediatr Crit Care Med 3:112–116
Bauer AM, Quas JA, Boyce WT (2002) Associations between physiological reactivity and children’s behavior: advantages of a multisystem approach. J Dev Behav Pediatr 23:102–113
Carrion VG, Weems CF, Ray RD, Glaser B, Hess LD, Reiss AL (2002) Diurnal salivary cortisol in pediatric posttraumatic stress disorder. Biol Psychiatry 51:575–582
Pfeffer CR, Altemus M, Heo M, Jiang H (2007) Salivary cortisol and psychopathology in children bereaved by the September 11, 2001 terror attacks. Biol Psychiatry 61:957–965
Danese A, McEwen BS (2012) Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiol Behav 106:29–39
Cicchetti D (2013) Review: Resilient functioning in maltreated children—past, present, and future perspectives. J Child Psychol Psyc 54:402–422
Hollocks MJ, Pickles A, Howlin P et al (2016) Dual Cognitive and Biological Correlates of Anxiety in Autism Spectrum Disorders. J Autism Dev Disord. doi:10.1007/s10803-016-2878-2
Delahanty DL, Nugent NR, Christopher NC, Walsh M (2005) Initial urinary epinephrine and cortisol levels predict acute PTSD symptoms in child trauma victims. Psychoneuroendocrin 30:121–128
Pervanidou P, Kolaitis G, Charitaki S, Margeli A, Ferentinos S, Bakoula C, Lazaropoulou C, Papassotiriou I, Tsiantis J, Chrousos GP (2007) Elevated morning serum interleukin (IL)-6 or evening salivary cortisol concentrations predict posttraumatic stress disorder in children and adolescents six months after a motor vehicle accident. Psychoneuroendocrin 32:991–999
Rosmalen JGM, Oldehinkela AJ, Ormela J, de Wintera AF, Buitelaar JK, Verhulst FC (2005) Determinants of salivary cortisol levels in 10–12 year old children; a population-based study of individual differences. Psychoneuroendocrin 30:483–495
Bartels M, de Geus EJC, Kirschbaum C et al (2003) Heritability of daytime cortisol levels in children. Behav Genet 33:421–433
Als L, Nadel S, Cooper M, Pierce CM, Sahakian BJ, Garralda ME (2013) Neuropsychological function five months following admission to paediatric intensive care with meningo-encephalitis, sepsis, and other disorders: a prospective study of school-aged children. Crit Care Med 41:1094–1103
O’Connor TG, Ben Schlomo Y, Heron J, Golding J, Adams D, Glover V (2005) Prenatal anxiety predicts individual differences in cortisol in pre-adolescent children. Biol Psychiatry 58:211–217
Arafah BM, Nishiyama FJ, Tlaygeh H, Hejal R (2007) Measurement of salivary cortisol concentration in the assessment of adrenal function in critically ill subjects: a surrogate marker of the circulating free cortisol. J Clin Endocrinol Metab 92:2965–2971
Woodside DB, Winter K, Fisma S (1991) Salivary cortisol in children: correlations with serum values and effect of psychotropic drug administration. Can J Psychiatry 36:746–748
Clements AD, Parker CR (1998) The relationship between salivary cortisol concentrations in frozen versus mailed samples. Psychoneuroendocrin 23:613–616
Herrington CJ, Olomu IN, Geller SM (2004) Salivary cortisol as indicators of pain in preterm infants: a pilot study. Clin Nurs Res 13:53–68
Slater A, Shann F, Pearson G (2003) Paediatric Index of Mortality (PIM) Study Group: pIM2: a revised version of the Paediatric Index of Mortality. Intensive Care Med 29:278–285
Dyregrov A, Yule W (1995) Screening measures: the development of the UNICEF screening battery. In: Paper presented at the 9th Annual Meeting of the International Society of Stress Studies. Boston, MA
Perrin S, Meiser-Stedman R, Smith P (2005) The Children’s Revised Impact of Event Scale (CRIES): validity as a screening instrument for PTSD. Behav Cogn Psychoth 33:487–498
Fries E, Dettenborn L, Kirschbaum C (2009) The cortisol awakening response (CAR): facts and future directions. Int J Psychophysiol 72:67–73
Kirschbaum C, Kudielka BM, Gaab J, Schommer NC, Hellhammer DH (1999) Impact of gender, menstrual cycle phase, and oral contraceptives on the activity of the hypothalamus-pituitary-adrenal axis. Psychosom Med 61:154–162
Oskis A, Loveday C, Hucklebridge F, Thorn Clow A (2009) Diurnal patterns of salivary cortisol across the adolescent period in healthy females. Psychoneuroendocrin 34:307–316
Bornstein SR, Licinio J, Tauchnitz R, Engelmann L, Negrao AB, Gold P, Chrousos GP (1998) Plasma leptin levels are increased in survivors of acute sepsis: associated loss of diurnal rhythm in cortisol and leptin secretion. J Clin Endocrinol Metab 83:280–283
Pruessner JC, Wolf OT, Hellhammer DH, Buske-Kirschbaum A, von Auer K, Jobst S, Kaspers F, Kirschbaum C (1997) Free cortisol levels after awakening: a reliable biological marker for the assessment of adrenocortical activity. Life Sci 61:2539–2549
O’Donnell KJ, Glover V, Jenkins J, Browne D, Ben-Shlomo Y, Golding J, O’Connor TG (2013) Prenatal maternal mood is associated with altered diurnal cortisol in adolescence. Psychoneuroendocrin 38:1630–1638. doi:10.1016/j.psyneuen.2013.01.008
Weems CF, Carrion VG (2007) The association between PTSD symptoms and salivary cortisol in youth: the role of time since the trauma. J Trauma Stress 20:903–907
Wessaa M, Rohlederb M, Kirschbaumb C, Flora H (2006) Altered cortisol awakening response in posttraumatic stress disorder. Psychoneuroendocrin 31:209–215
Schelling G, Kilger E, Roozendaal B, de Quervain DJ, Briegel J, Dagge A et al (2004) Stress doses of hydrocortisone, traumatic memories, and symptoms of posttraumatic stress disorder in patients after cardiac surgery: a randomized study. Biol Psychiatry 55:627–633
Picouto MD (2012) Psychological function and biological stress markers in children following admission to intensive care. Dissertation, Universidad de Alcala, Spain
Colville G, Kerry S, Pierce C (2008) Children’s factual and delusional memories of intensive care. Am J Respir Crit Care Med 177:976–982
Gunnar MR (2001) The role of glucocorticoids in anxiety disorders. A critical analysis. In: Vasey MW, Dadds MR (eds) The developmental psychopathology of anxiety. Oxford University Press, New York, pp 143–159