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- W2315929148 abstract "Introduction: Previous genome-wide expression studies demonstrated a subclass of children with septic shock characterized by repression of genes corresponding to the glucocorticoid receptor (GCR) signaling pathway. This subclass had higher illness severity and higher mortality, compared to other subclasses (Wong et al. BMC Med 2009 7:34) Hypothesis: We tested the hypothesis that decreased GCR expression correlates with the degree of illness severity in critically ill children. Methods: GCR expression was measured by flow cytometry in lymphocytes (Ly) and parallel cortisol level were collected. Mean fluorescence (MF) values minus background fluorescence (FMO) were analyzed for correlation with clinical data. Results: Cohort: 36 critically ill children, median age 86 months (IQR 24-127), 56% males, median PRISM III 6 (IQR 2-11), median # organ failures (OF) 1 (IQR 0-3), 13 subjects received cardiovascular support (shock group 36%) and 19 subjects received steroids (steroids group 53%). Specific findings: Shock group patients had lower GCR expression in CD8Ly (mean 812 vs 1076, p=0.05) and a trend for lower expression in CD4Ly (mean 731 vs 956, p=0.07), compared to non shock patients. Steroid administration did not correlate with GCR expression. Subjects with? 2 OF in the first 7 days of admission had lower GCR expression in CD4Ly (median 635 vs 897, p=0.045) and CD8Ly (mean 833 vs 1129, p=0.026) when compared with subjects with? 1 OF. Patients with a PRISM III value? 7 showed a trend for lower GCR expression in CD4Ly (mean 773 vs 977, p=0.08) and CD8Ly (mean 865 vs 1097, p=0.07) when compared with patients having PRISM III scores < 7. Cortisol? 7.5 mcg/dL were associated with a lower GCR expression when compared with cortisol levels < 7.5 (CD4Ly median 626 vs 859, p=0.045, CD8Ly median 754 vs 1004, p=0.024). Conclusions: This preliminary sudy suggests that patients with shock and increased illness severity have lower GCR expression in Ly, consistent with gene expression studies. If this association holds true across a larger sample size, it may have conceptual implications for critical illness-related corticosteroid insufficiency.Supported in part by the Nurturing Children’s Development Program, Procter & Gamble Co." @default.
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- W2315929148 date "2012-12-01" @default.
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- W2315929148 doi "https://doi.org/10.1097/01.ccm.0000424486.10425.aa" @default.
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