title: Adrenal response in patients with septic shock of abdominal origin: relationship to survival.
abstract: OBJECTIVE
  To evaluate the prognostic value of adrenocortical response to corticotropin in septic shock patients operated on exclusively for an intra-abdominal source of infection.
  
  
  METHODS
  Prospective, observational, single-center study in a surgical intensive care unit of a university hospital
  
  
  METHODS
  118 consecutive septic shock patients undergoing laparotomy or drainage for intra-abdominal infection.
  
  
  RESULTS
  Baseline cortisol (t (0)) and cortisol response to corticotropin test (Delta) were measured during the first 24 h following onset of shock. The relationship between adrenal function test results and survival was analyzed as well as the effect of etomidate anesthesia. Cortisol plasma level at t (0) was higher in nonsurvivors than in survivors (33 +/- 23 vs. 25 +/- 14 microg/dl), but the response to corticotropin test did not differ between these two subgroups. ROC analysis showed threshold values for t (0) (32 microg/dl) and Delta (8 microg/dl) that best discriminated survivors from nonsurvivors in our population. We observed no difference in survival at the end of hospital stay using log rank test when patients were separated according to t (0), Delta, or both. In addition, adrenal function tests and survival did not differ in patients who received etomidate anesthesia (n = 69) during the surgical treatment of their abdominal sepsis.
  
  
  CONCLUSIONS
  In this cohort of patients with abdominal septic shock baseline cortisol level and the response to corticotropin test did not discriminate survivors from nonsurvivors. No deleterious impact of etomidate anesthesia on adrenal function tests and survival was observed in these patients.
authors.affiliation: Department of Anesthesiology and Intensive Care, Hôpital Lariboisière, AP-HP, Université Paris VII, 2 rue Ambroise Paré, 75010, Paris, France.
authors.forename: Florence C
authors.initials: FC
authors.lastname: Riché
authors.forename: Carole M
authors.initials: CM
authors.lastname: Boutron
authors.forename: Patrice
authors.initials: P
authors.lastname: Valleur
authors.forename: Christine
authors.initials: C
authors.lastname: Berton
authors.forename: Marie-Josèphe
authors.initials: MJ
authors.lastname: Laisné
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Launay
authors.forename: Philippe
authors.initials: P
authors.lastname: Chappuis
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Peynet
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.forename: Didier
authors.initials: D
authors.lastname: Payen
authors.forename: Bernard P
authors.initials: BP
authors.lastname: Cholley
mesh_terms: D000005:Abdomen; D000311:Adrenal Glands / Q000503:physiopathology*; D000324:Adrenocorticotropic Hormone; D000368:Aged; D018686:Anesthetics, Intravenous; D005045:Etomidate; D005260:Female; D006785:Hospitals, University; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007362:Intensive Care Units; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012772:Shock, Septic / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D015996:Survival Rate
chemical_list: D018686:Anesthetics, Intravenous; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone; D005045:Etomidate