title: Adrenal function in sepsis: the retrospective Corticus cohort study.
abstract: OBJECTIVE
  To refine the value of baseline and adrenocorticotropin hormone (ACTH)-stimulated cortisol levels in relation to mortality from severe sepsis or septic shock.
  
  
  METHODS
  Retrospective multicenter cohort study.
  
  
  METHODS
  Twenty European intensive care units.
  
  
  METHODS
  Patients included 477 patients with severe sepsis and septic shock who had undergone an ACTH stimulation test on the day of the onset of severe sepsis.
  
  
  METHODS
  None.
  
  
  RESULTS
  Compared with survivors, nonsurvivors had higher baseline cortisol levels (29.5 +/- 33.5 vs. 24.3 +/- 16.5 microg/dL, p = .03) but similar peak cortisol values (37.6 +/- 40.2 vs. 35.2 +/- 22.9 microg/dL, p = .42). Thus, nonsurvivors had lower Deltamax (i.e., peak cortisol minus baseline cortisol) (6.4 +/- 22.6 vs. 10.9 +/- 12.9 microg/dL, p = .006). Patients with either baseline cortisol levels <15 microg/dL or a Deltamax <or=9 microg/dL had a likelihood ratio of dying of 1.26 (95% confidence interval, 1.11-1.44), a longer duration of shock, and a shorter survival time. Patients with a Deltamax <or=9 microg/dL but any baseline cortisol value had a likelihood ratio of dying of 1.38 (95% confidence interval, 1.18-1.61).
  
  
  CONCLUSIONS
  Although delta cortisol and not basal cortisol level was associated with clinical outcome, further studies are still needed to optimize the diagnosis of adrenal insufficiency in critical illness. Etomidate influenced ACTH test results and was associated with a worse outcome.
authors.affiliation: Service de Réanimation, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ), Garches, France.
authors.forename: Diane
authors.initials: D
authors.lastname: Lipiner-Friedman
authors.forename: Charles L
authors.initials: CL
authors.lastname: Sprung
authors.forename: Pierre François
authors.initials: PF
authors.lastname: Laterre
authors.forename: Yoram
authors.initials: Y
authors.lastname: Weiss
authors.forename: Sergey V
authors.initials: SV
authors.lastname: Goodman
authors.forename: Michael
authors.initials: M
authors.lastname: Vogeser
authors.forename: Josef
authors.initials: J
authors.lastname: Briegel
authors.forename: Didier
authors.initials: D
authors.lastname: Keh
authors.forename: Mervyn
authors.initials: M
authors.lastname: Singer
authors.forename: Rui
authors.initials: R
authors.lastname: Moreno
authors.forename: Eric
authors.initials: E
authors.lastname: Bellissant
authors.forename: Djillali
authors.initials: D
authors.lastname: Annane
mesh_terms: D000309:Adrenal Insufficiency / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D000324:Adrenocorticotropic Hormone; D000367:Age Factors; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000401:mortality / Q000503:physiopathology*; D012737:Sex Factors; D012772:Shock, Septic / Q000401:mortality / Q000503:physiopathology
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone