title: Basal serum cortisol levels are not predictive of response to corticotropin but have prognostic significance in patients with septic shock.
abstract: Because high levels of cortisol are frequently observed in patients with septic shock, low levels of serum cortisol are considered indicative of relative adrenal insufficiency (RAI). This study was performed to investigate whether pretest clinical characteristics, including basal serum cortisol levels, are predictive of serum cortisol response to corticotropin and whether basal cortisol levels have a prognostic significance in patients with septic shock. We performed a retrospective analysis of 68 patients with septic shock who underwent short corticotropin stimulation testing. RAI was defined as an increase in cortisol level <9 microgram/dL from baseline, and results showed that 48 patients (70.6%) had this insufficiency. According to the univariate analysis, the RAI group had significantly higher simplified acute physiology score II (SAPS II) and sequential organ failure assessment (SOFA) scores than the non-RAI group. The incidence of RAI was the same regardless of the basal serum cortisol level (p=0.447). The hospital mortality rate was 58.8% and was not significantly different between the RAI and non-RAI groups. However, a high basal serum cortisol level (> or =30 microgram/dL) was significantly associated with in-hospital mortality. In conclusion, our data suggest that basal serum cortisol levels are not predictive of serum cortisol response to corticotropin but have a significant prognostic value in patients with septic shock.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, Korea.
authors.forename: Yong Soo
authors.initials: YS
authors.lastname: Kwon
authors.forename: Gee Young
authors.initials: GY
authors.lastname: Suh
authors.forename: Eun-Hae
authors.initials: EH
authors.lastname: Kang
authors.forename: Won-Jung
authors.initials: WJ
authors.lastname: Koh
authors.forename: Man Pyo
authors.initials: MP
authors.lastname: Chung
authors.forename: Hojoong
authors.initials: H
authors.lastname: Kim
authors.forename: O Jung
authors.initials: OJ
authors.lastname: Kwon
mesh_terms: D000309:Adrenal Insufficiency / Q000097:blood / Q000175:diagnosis; D000324:Adrenocorticotropic Hormone / Q000494:pharmacology*; D000368:Aged; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012016:Reference Values; D012772:Shock, Septic / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone