Cortisol changes among patients with septic shock and the relationship to ICU and hospital stay.
OBJECTIVE
To evaluate adrenal function in patients with severe sepsis or septic shock.


METHODS
A prospective study of unstimulated and high-dose ACTH stimulated cortisol levels on days 1 and 2 following ICU admission and day 28 or last day of hospitalization (herein day 28).


METHODS
General intensive care unit.


METHODS
34 septic patients.


METHODS
On days 1, 2, and 28 of sepsis unstimulated and ACTH stimulated cortisol levels were evaluated. End-points were length of ICU and hospital stay and 28 day all cause mortality.


RESULTS
Eight patients on days 1 and 2 had criteria of adrenal insufficiency defined as unstimulated cortisol levels less than 15 microg/dl. Patients with unstimulated cortisol levels less than 15 microg/dl on day 1 or change of 9 microg/dl or less had longer ICU stays. Patients with unstimulated cortisol levels less than 15 microg/dl on day 1 also demonstrated longer hospital stay. On day 1 regression analysis revealed that unstimulated cortisol levels had a significant inverse correlation with length of ICU and hospital stay. The proportional change between unstimulated cortisol and post-ACTH cortisol (Delta%) is a new modality; the higher this Delta% value, the longer is the patient's ICU and hospital stay. A significant positive correlation was found in survivors when comparing unstimulated cortisol vs. day 28 changes.


CONCLUSIONS
The present study highlights the wide range of cortisol levels among patients with sepsis. We observed a difference in cortisol response pattern between survivors and nonsurvivors on day 28. The proportional change between unstimulated cortisol and post-ACTH cortisol was used as a method to evaluate the relative change in cortisol levels between patients.
Goodman
Sergei
S
Department of Anesthesiology and Critical Care Medicine, Hadassah University Hospital, Hadassah Medical School, Hebrew University, P.O.B. 12000, 91120 Jerusalem, Israel.
Sprung
Charles L
CL
Ziegler
Daniel
D
Weiss
Yoram G
YG
D000324:Adrenocorticotropic Hormone / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006728:Hormones / Q000494:pharmacology*; D017052:Hospital Mortality; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood* / Q000145:classification
D006728:Hormones; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone