Critical Illness-Related Corticosteroid Insufficiency (CIRCI)

A narrative review from a multispecialty task force of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM)

Djillali Annane, Stephen M. Pastores, Wiebke Arlt, Robert A. Balk, Albertus Beishuizen, Josef Briegel, Joseph Carcillo, Mirjam Christ-Crain, Mark S. Cooper, Paul E. Marik, Gianfranco Meduri, Keith M. Olsen, Bram Rochwerg, Sophia C. Rodgers, James A. Russell, Greet Van Den Berghe

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective: To provide a narrative review of the latest concepts and understanding of the pathophysiology of critical illness-related corticosteroid insufficiency (CIRCI). Participants: A multi-specialty task force of international experts in critical care medicine and endocrinology and members of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. Data Sources: Medline, Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews. Results: Three major pathophysiologic events were considered to constitute CIRCI: Dysregulation of the hypothalamic-pituitary- adrenal (HPA) axis, altered cortisol metabolism, and tissue resistance to glucocorticoids. The dysregulation of the HPA axis is complex, involving multidirectional crosstalk between the CRH/ ACTH pathways, autonomic nervous system, vasopressinergic system, and immune system. Recent studies have demonstrated that plasma clearance of cortisol is markedly reduced during critical illness, explained by suppressed expression and activity of the primary cortisol-metabolizing enzymes in the liver and kidney. Despite the elevated cortisol levels during critical illness, tissue resistance to glucocorticoids is believed to occur due to insufficient glucocorticoid alpha-mediated anti-inflammatory activity. Conclusions: Novel insights into the pathophysiology of CIRCI add to the limitations of the current diagnostic tools to identify at-risk patients and may also impact how corticosteroids are used in patients with CIRCI.

Original languageEnglish (US)
Pages (from-to)2089-2098
Number of pages10
JournalCritical care medicine
Volume45
Issue number12
DOIs
StatePublished - Jan 1 2017

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Advisory Committees
Critical Illness
Adrenal Cortex Hormones
Hydrocortisone
Databases
Endocrinology
Information Storage and Retrieval
Autonomic Nervous System
Critical Care
Adrenocorticotropic Hormone
Glucocorticoids
Immune System
Anti-Inflammatory Agents
Medicine
Kidney
Liver
Enzymes

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Critical Illness-Related Corticosteroid Insufficiency (CIRCI) : A narrative review from a multispecialty task force of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM). / Annane, Djillali; Pastores, Stephen M.; Arlt, Wiebke; Balk, Robert A.; Beishuizen, Albertus; Briegel, Josef; Carcillo, Joseph; Christ-Crain, Mirjam; Cooper, Mark S.; Marik, Paul E.; Meduri, Gianfranco; Olsen, Keith M.; Rochwerg, Bram; Rodgers, Sophia C.; Russell, James A.; Van Den Berghe, Greet.

In: Critical care medicine, Vol. 45, No. 12, 01.01.2017, p. 2089-2098.

Research output: Contribution to journalArticle

Annane, D, Pastores, SM, Arlt, W, Balk, RA, Beishuizen, A, Briegel, J, Carcillo, J, Christ-Crain, M, Cooper, MS, Marik, PE, Meduri, G, Olsen, KM, Rochwerg, B, Rodgers, SC, Russell, JA & Van Den Berghe, G 2017, 'Critical Illness-Related Corticosteroid Insufficiency (CIRCI): A narrative review from a multispecialty task force of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM)', Critical care medicine, vol. 45, no. 12, pp. 2089-2098. https://doi.org/10.1097/CCM.0000000000002724
Annane, Djillali ; Pastores, Stephen M. ; Arlt, Wiebke ; Balk, Robert A. ; Beishuizen, Albertus ; Briegel, Josef ; Carcillo, Joseph ; Christ-Crain, Mirjam ; Cooper, Mark S. ; Marik, Paul E. ; Meduri, Gianfranco ; Olsen, Keith M. ; Rochwerg, Bram ; Rodgers, Sophia C. ; Russell, James A. ; Van Den Berghe, Greet. / Critical Illness-Related Corticosteroid Insufficiency (CIRCI) : A narrative review from a multispecialty task force of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM). In: Critical care medicine. 2017 ; Vol. 45, No. 12. pp. 2089-2098.
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T2 - A narrative review from a multispecialty task force of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM)

AU - Annane, Djillali

AU - Pastores, Stephen M.

AU - Arlt, Wiebke

AU - Balk, Robert A.

AU - Beishuizen, Albertus

AU - Briegel, Josef

AU - Carcillo, Joseph

AU - Christ-Crain, Mirjam

AU - Cooper, Mark S.

AU - Marik, Paul E.

AU - Meduri, Gianfranco

AU - Olsen, Keith M.

AU - Rochwerg, Bram

AU - Rodgers, Sophia C.

AU - Russell, James A.

AU - Van Den Berghe, Greet

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Objective: To provide a narrative review of the latest concepts and understanding of the pathophysiology of critical illness-related corticosteroid insufficiency (CIRCI). Participants: A multi-specialty task force of international experts in critical care medicine and endocrinology and members of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. Data Sources: Medline, Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews. Results: Three major pathophysiologic events were considered to constitute CIRCI: Dysregulation of the hypothalamic-pituitary- adrenal (HPA) axis, altered cortisol metabolism, and tissue resistance to glucocorticoids. The dysregulation of the HPA axis is complex, involving multidirectional crosstalk between the CRH/ ACTH pathways, autonomic nervous system, vasopressinergic system, and immune system. Recent studies have demonstrated that plasma clearance of cortisol is markedly reduced during critical illness, explained by suppressed expression and activity of the primary cortisol-metabolizing enzymes in the liver and kidney. Despite the elevated cortisol levels during critical illness, tissue resistance to glucocorticoids is believed to occur due to insufficient glucocorticoid alpha-mediated anti-inflammatory activity. Conclusions: Novel insights into the pathophysiology of CIRCI add to the limitations of the current diagnostic tools to identify at-risk patients and may also impact how corticosteroids are used in patients with CIRCI.

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