• Audrey R Ogawa Shibata, Eduardo J Troster, and Hector R Wong.
• 1Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Israelita Albert Einstein, Sao Paulo, Brazil. 2Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Hospital Research Foundation, Cincinnati, OH.
• Pediatr Crit Care Me. 2015 Jun 1;16(5):e132-40.

ObjectivesTo characterize glucocorticoid receptor expression in peripheral WBCs of critically ill children using flow cytometry.DesignProspective observational cohort.SettingA university-affiliated, tertiary PICU.PatientsFifty-two critically ill children.InterventionsSamples collected for measurement of glucocorticoid receptor expression and parallel cortisol levels.Measurements And Main ResultsSubjects with cardiovascular failure had significantly lower glucocorticoid receptor expression both in CD4 lymphocytes (mean fluorescence intensity, 522 [354-787] vs 830 [511-1,219]; p = 0.036) and CD8 lymphocytes (mean fluorescence intensity, 686 [350-835] vs 946 [558-1,511]; p = 0.019) compared with subjects without cardiovascular failure. Subjects in the upper 50th percentile of Pediatric Risk of Mortality III scores and organ failure also had significantly lower glucocorticoid receptor expression in CD4 and CD8 lymphocytes. There was no linear correlation between cortisol concentrations and glucocorticoid receptor expression.ConclusionsOur study suggests that patients with shock and increased severity of illness have lower glucocorticoid receptor expression in CD4 and CD8 lymphocytes. Glucocorticoid receptor expression does not correlate well with cortisol levels. Future studies could focus on studying glucocorticoid receptor expression variability and isoform distribution in the pediatric critically ill population as well as on different strategies to optimize glucocorticoid response.

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