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Objectives and questions: The term critical illness-related corticosteroid insufficiency (CIRCI) was introduced by the Society of Critical Care Medicine in 2018 and is characterized by a dysregulation of the systemic inflammatory response in a setting of critical illness, resulting from inadequate intracellular glucocorticoid-mediated anti-inflammatory activity with a corresponding negative impact on the clinical outcome. While cortisol stress response is well studied in pathologies like septic shock, data on patients undergoing trauma surgery is scarce. Therefore, this collective is not covered by the 2017 published “Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency in critically ill patients”. The current study investigates cortisol stress response in geriatric trauma patients.

Material and methods: This is a prospective study on 20 geriatric patients (15 female, 5 male) that underwent surgery for proximal femur fracture and were postoperatively admitted to an Intensive Care Unit (ICU) between 09/2023 and 08/2024. Patients with prior cortisol medication or history of hypophyseal tumour were excluded. Reasons for admission to ICU were circulatory instability (15 cases), respiratory insufficiency (2 cases), neurological symptoms (2 cases), and electrolyte imbalance (1 case). Mean age was 88 years (range 75–98, SD 6.7). Inflammation markers and cortisol levels were determined on the first postoperative day. CIRCI was defined as a cortisol level <276nmol/l. Descriptive statistics were performed to describe means, medians and range for all variables. Cortisol levels were compared to inflammatory blood markers and patient characteristics with linear regression analysis.

Results: 35% of patients met the criteria for CIRCI. Cortisol levels correlated with Interleukin 6 (IL-6) levels (p=0,005) and procalcitonin (PCT) levels (p=0.037). No correlation was found for c-reactive protein or leucocyte count. Catecholamine demand at the day of surgery did not correlate with cortisol levels (p=0,284). No correlation was found between cortisol levels and the following patient characteristics: a) duration of surgery (p=0,769), b) time between surgery and blood draw (p=0,536), c) age (p=0,536), and d) body weight (p=0,950).

Discussion and conclusions: The determination of cortisol levels should be considered in geriatric patients with unspecific circulatory, respiratory, or neurological symptoms on the first day following surgery for proximal femur fractures. Thereby, patients suffering from CIRCI can be identified and adequate treatment, such as probatory administration of hydrocortisone, can be initiated. Moreover, IL-6 and PCT may represent reliable markers for the monitoring of postoperative endocrine stress response in geriatric trauma patients.