Adrenal axis function does not appear to be associated with hemodynamic improvement in septic shock patients systematically receiving glucocorticoid therapy.
OBJECTIVE
There is mounting evidence showing the value of low-dose corticosteroids in patients with septic shock requiring vasopressor therapy. It remains unclear whether adrenal function tests should be carried out systematically to guide the decision on glucocorticoid therapy.


METHODS
The retrospective study was conducted in 52 patients in three university hospital ICUs. We included consecutive patients with catecholamine-dependent septic shock who had not received ketoconazole, glucocorticoids, or etomidate in the 24 h before the ACTH test, and who had survived to day 3 after the shock onset. All patients had a 250-microg ACTH test before systematic glucocorticoid therapy was started. Various definitions of relative adrenal insufficiency were used (based on cortisol basal level and/or change in cortisol level after ACTH stimulation). We defined hemodynamic improvement as a 50% reduction in the vasoactive agent dose in the 3 days following the initiation of glucocorticoid treatment. The relationship between the hemodynamic improvement and the results of the adrenal function tests was analyzed.


RESULTS
Hemodynamic improvement occurred in 29 patients (55.8%). Baseline characteristics, sites of infection, types of micro-organisms and antibiotic management did not differ between patients with and those without hemodynamic improvement. Relative adrenal insufficiency whatever the definition was not associated with hemodynamic improvement.


CONCLUSIONS
In catecholamine-dependent septic shock patients managed with systematic glucocorticoid therapy the results of ACTH stimulation do not predict hemodynamic improvement.
Morel
Jerome
J
Polyvalent Intensive Care Unit, Hospital Bellevue, 42055 Saint Etienne Cedex 2, France.
Venet
Christophe
C
Donati
Yannis
Y
Charier
David
D
Liotier
Jerome
J
Frere-Meunier
Delphine
D
Guyomarc'h
Stephane
S
Diconne
Eric
E
Bertrand
Jean Claude
JC
Souweine
Bertrand
B
Papazian
Laurent
L
Zeni
Fabrice
F
D000311:Adrenal Glands / Q000187:drug effects / Q000503:physiopathology*; D000368:Aged; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D005938:Glucocorticoids; D014662:Vasoconstrictor Agents; D006854:Hydrocortisone