Adrenocortical function and multiple organ failure in severe sepsis.
BACKGROUND
Some patients with severe sepsis may have relative adrenocortical insufficiency, although not all studies confirm this finding. Corticosteroids play an important role in controlling excessive immune response, and they may reduce the severity of organ dysfunction in critical illness. In this prospective study, we investigated the incidence of adrenal insufficiency in severe sepsis and its relation to the development of multiple organ failure.


METHODS
Forty-one patients meeting the criteria for severe sepsis were studied. A short ACTH stimulation test was carried out within 24 h of the diagnosis of sepsis. Peak serum cortisol level < 680 nmol/L and a rise of less than 260 nmol/L were used as the criteria for relative adrenocortical insufficiency.


RESULTS
Relative adrenocortical insufficiency was detected in six patients. Duration of the ICU stay (P = 0.002) and mechanical ventilation (P = 0.024) were significantly longer in patients with impaired adrenal function. In the survivors, SOFA scores were significantly higher in patients with impaired adrenal function. The plasma ACTH levels were normal in most of the patients with relative adrenal insufficiency, whereas most patients with normal adrenal function had extremely low plasma ACTH levels.


CONCLUSIONS
The ICU stay was longer and multiple organ failure more severe in patients with impaired adrenocortical function. There was a clear dissociation between ACTH and cortisol levels in AAR patients. This finding suggests that the integrity of the hypothalamic-pituitary-adrenal axis may be impaired in severe sepsis.
Loisa
P
P
Department of Anesthesia and Intensive Care, Tampere University Hospital, Tampere, Finland. pekka.loisa@phks.fi
Rinne
T
T
Kaukinen
S
S
D000302:Adrenal Cortex / Q000503:physiopathology*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications* / Q000503:physiopathology
D000324:Adrenocorticotropic Hormone