Adrenal function in sepsis: the retrospective Corticus cohort study.
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.
Lipiner-Friedman
Diane
D
Service de Réanimation, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ), Garches, France.
Sprung
Charles L
CL
Laterre
Pierre François
PF
Weiss
Yoram
Y
Goodman
Sergey V
SV
Vogeser
Michael
M
Briegel
Josef
J
Keh
Didier
D
Singer
Mervyn
M
Moreno
Rui
R
Bellissant
Eric
E
Annane
Djillali
D
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
D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone