Similarly, assessment of pulsatile secretion of hypothalamohypophyseal hormones would also sellectchem have been interesting. Because such assessments require repeated measurements, comprehensive hormonal studies have included a relatively small number of patients [37].We acknowledge that a statistical association does not signify a causal relationship. Endocrinological dysfunction and mortality might be two independent consequences of critical illness. Because of the relatively low number of events, we did not perform multivariate analyses to determine whether endocrinological dysfunction was independently associated with in-hospital mortality. It is also possible that a larger patient cohort would have allowed us to identify other endocrinological factors.

Despite these limitations, our study remains original, as we have assessed the relationships between various hormones and mortality at the postacute phase of critical illness in a patient cohort that is relatively large in comparison with other similar studies. It has to be noted that hormones were not chosen at random, but rather because they might affect outcomes, including even gonadotropic hormones [3,38].We have used the term “protracted” because assessment of plasma hormone levels was done after the seventh day of critical illness. Indeed, this time point is often used to discriminate the acute phase from the postacute phase of critical illness. We acknowledge that this definition is too simple, because “time” is not the same for all patients and all types of critical illness.

From a clinical point of view, awakening is a major milestone in the course of critical illness. It often indicates recovery, and it is a time when important therapeutic decisions are made, such ventilator weaning or physiotherapy.ConclusionsWe found that in-hospital mortality was associated with high plasma cortisol and low plasma IGF-1 levels in the whole patient population, with low plasma DHEA and DHEAS levels in men and with increased blood glucose levels in women. Before attempting to conduct a clinical trial on hormonal therapy, we think that these associations should be confirmed in a larger patient cohort and that their pathogenic mechanisms should be elucidated.Key messages? The impact of endocrinological dysfunction in the Drug_discovery postacute phase of critical illness has been scantly assessed.? The adrenal, thyrotropic, somatotropic and gonadotropic axes were assessed in 102 patients (65 men and 37 women) who had required mechanical ventilation for at least seven days (median, 10 days).? The in-hospital mortality rate was 24%.? The plasma level of IGF-1 was higher and that of cortisol was lower in survivors, regardless of sex.? Plasma levels of DHEA and DHEAS were higher in men who survived.