Glucocorticoid treatment increases cholesterol availability during critical illness: effect on adrenal and muscle function
Authors' conclusion
Glucocorticoid treatment partially attenuated critical illness-induced hypocholesterolemia, but at a cost of impaired adrenal function, suppressed muscle regeneration and exacerbated loss of body mass.
Study context
- Population
- Prolonged critically ill patients (EPaNIC RCT) and septic mice (cecal ligation and puncture)
- Participants
- 324 matched patients
- Comparison
- Glucocorticoid treatment vs placebo/no treatment
- Hydrocortisonen = 17
- Placebon = 15reference
- Healthyn = 18
- Outcome
- Association between glucocorticoid treatment and plasma cholesterol from ICU admission to day five
- Follow-up
- Up to day five
Methodological detailssecondary analysis of the EPaNIC RCT (matched set), mouse model of cecal ligation and puncture-induced sepsis, randomised
- Secondary analysis of the EPaNIC RCT (matched set)
- Mouse model of cecal ligation and puncture-induced sepsis
- Randomised
Main finding
As reported in the abstract
- Patients: glucocorticoid treatment associated with higher plasma HDL- and LDL-cholesterol from ICU day 2 and day 3 respectively, up to day 5
- P < 0.05
- Mice: plasma corticosterone no longer elevated with hydrocortisone vs placebo; sepsis-induced reduction in plasma HDL- and LDL-cholesterol and adrenocortical cholesterol attenuated
- P < 0.05
Further findings
Adrenal function (mice)
- No improvement in adrenocortical ACTH-induced CORT response; increased adrenocortical inflammation and apoptosis with hydrocortisone
- P < 0.05
Muscle (mice)
- Markers of muscle regeneration suppressed vs placebo
- P < 0.05
- No additional effect on muscle mass, force or myofiber size; sepsis-induced rise in atrophy and fibrosis markers unaffected
Safety
Body mass and composition (mice)
- Total body mass further decreased with hydrocortisone vs placebo
- P < 0.01
- Increased loss of lean body mass and total and free water with hydrocortisone vs placebo
- P < 0.05
- Consecutive mouse study, n = 24
Original publication
Glucocorticoid treatment increases cholesterol availability during critical illness: effect on adrenal and muscle function. Crit Care. Published 5 September 2024. doi:10.
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