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  • Title: Serum free cortisol fraction in healthy and septic neonatal foals.
    Author: Hart KA, Barton MH, Ferguson DC, Berghaus R, Slovis NM, Heusner GL, Hurley DJ.
    Journal: J Vet Intern Med; 2011; 25(2):345-55. PubMed ID: 21281351.
    Abstract:
    BACKGROUND: Relative cortisol insufficiency occurs in septic foals and impacts survival. Serum free (biologically available) cortisol concentration might be a better indicator of physiologic cortisol status than serum total cortisol concentration in foals. HYPOTHESES: In septic foals, (1) low free cortisol concentration correlates with disease severity and survival and (2) predicts disease severity and outcome better than total cortisol concentration. ANIMALS: Fifty-one septic foals; 11 healthy foals; 6 healthy horses. METHODS: In this prospective clinical study, foals meeting criteria for sepsis at admission were enrolled. University-owned animals served as healthy controls. Basal and cosyntropin-stimulated total cortisol concentration and percent free cortisol (% free cortisol) were determined by chemiluminescent immunoassay and ultrafiltration/ligand-binding methods, respectively. Group data were compared by ANOVA, Mann-Whitney U-tests, and receiver operator characteristic curves. Significance was set at P < .05. RESULTS: Basal % free cortisol was highest in healthy foals at birth (58 ± 8% mean ± SD), and was higher (P ≤ .004) in healthy foals of all ages (33 ± 6 to 58 ± 8%) than in adult horses (7 ± 3%). Cosyntropin-stimulated total and free cortisol concentrations were lower (P ≤ .03) in foals with shock (total = 6.2 ± 8.1 μg/dL; free = 3.5 ± 4.8 μg/dL versus total = 10.8 ± 6.0 μg/dL; free = 6.9 ± 3.3 μg/dL in foals without shock) and in nonsurvivors (total = 3.8 ± 6.9 μg/dL; free = 1.9 ± 3.9 μg/dL versus total = 9.1 ± 7.7 μg/dL; free = 5.5 ± 4.4 μg/dL in survivors). Free cortisol was no better than total cortisol at predicting disease severity or outcome in septic foals. CONCLUSIONS AND CLINICAL IMPORTANCE: Serum free cortisol is impacted by age and illness in the horse. There is no advantage to measuring free over total cortisol in septic foals.
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