Abstract：Objective: To detect the levels of serum adrenocorticotropic hormone (ACTH) and free cortisol (COR) in elderly patients with severe nosocomial infection and to analyze the changes of the above factors and their clinical application value. Methods: From June 2015 to June 2018, 163 critically ill elderly patients in ICU ward of our hospital were selected. According to the criteria for the diagnosis of nosocomial infection, 76 patients were divided into infected patients (infection group), 87 cases without infection (control group)The levels of serum free COR,ACTH and serum potassium were measured in 8: 00 and 16: 00 in two groups. The changes of COR,ACTH and serum potassium levels in the two groups were analyzed and compared, Predictive value of serum free COR for infection by ROC curve analysis, the APACHE Ⅱ scores were recorded, the fatality rate of the two groups was observed at 28 days, and the changes of serum free COR,ACTH between survival and death patients were further observed. Results: The serum free COR at 8:00was (709.67 ±298.24) nmol/L, the level of serum free COR at 16:00 was (475.82 ±260.16) nmol/L, UFC was (185.94 ±161.29) g / 24 h and Apache Ⅱ score was (21.57 ±4.35)in the infected group. It was significantly higher than that of the control group [(364.03 ±152.78) nmol/L, (127.29 ±64.31) nmol/L, (71.31 ±16.44) μg / 24 h, (16.28 ±3.14), P<0. 01]. The fatality rate of 28 days in the infected group was significantly higher than that in the non-infected group (36.84% vs 3.45%, P<0.05). 8:00 the sensitivity of serum free COR to infection was 85.5, the specificity of serum free COR was 89.70.The sensitivity of serum free COR to infection was 97.4, and the specificity was 98.9;At 8:00, serum free COR was (1084.21 ±267.53) nmol/L,At16:00,serum free COR was (672.82 ±143.65) nmol/L, 8:00ACTH was (19.34 ±7.83) pmol/L,16:00ACTH was (17.58 ±5.63) pmol/L, UFC was (237.83 ±86.37) ?g/ 24 h in the death group. It was significantly higher than that in the survival group [(719.75 ±156.27) nmol/L, (268.29 ±78.37) nmol/L, (10.52 ±3.27) pmol/L, (9.74 ±3.96) pmol/L, (106.49 ±27.24)μg/24 h, P<0. 01]. Conclusions: The expression of serum free COR is higher in elderly patients with severe nosocomial infection. It can be used as an effective index for differentiating severe infection. At the same time, the high level of COR,ACTH may be related to the prognosis of the infected patients. The clinical monitoring of free COR and ACTH levels can be used to determine the prognosis of the patients.
李福财. 老年危重症医院感染患者血清游离COR ACTH水平及临床诊断价值[J]. 河北医学, 2019, 25(6): 1034-1037.
LI Fucai. Characteristics and Clinical Value of Serum Free COR,ACTH Levels in Elderly Patients with Severe Nosocomial Infection. HeBei Med, 2019, 25(6): 1034-1037.
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2019, Vol. 25 
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