title: Serum and salivary cortisol in the diagnosis of adrenal insufficiency and as a predictor of the outcome in patients with severe sepsis.
abstract: OBJECTIVE
  To compare salivary with serum total cortisol in patients with severe sepsis, postoperative patients and healthy controls.
  
  
  METHODS
  Serum total cortisol was determined by chemiluminescence immunoassay; salivary cortisol was determined by enzyme immunoassay.
  
  
  RESULTS
  In patients with severe sepsis, median concentration of salivary cortisol was 14.0 and 2.6 higher than that of postoperative patients and healthy subjects. In postoperative patients, salivary cortisol was 5.4 times higher than in control patients. Serum total cortisol was also higher in patients with severe sepsis than in controls and postoperative patients. This increment, however, was much lower (2.33 and 1.64, respectively). Patients with a salivary cortisol greater than 7.2 µg/dL had a mortality rate of 80%, a statistically significant result when compared with the group with lower cortisol levels (Z = 2.38 and p < 0.05).
  
  
  CONCLUSIONS
  Salivary cortisol in critically ill patients may be a better laboratory indicator of cortisol levels than serum total cortisol.
authors.affiliation: Complementary Propedeutics, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. romulomello@hotmail.com
authors.forename: Rômulo Carvalho Vaz de
authors.initials: RC
authors.lastname: Mello
authors.forename: Eduardo F
authors.initials: EF
authors.lastname: Sad
authors.forename: Bertha Coelho
authors.initials: BC
authors.lastname: Andrade
authors.forename: Suzane Pretti Figueiredo
authors.initials: SP
authors.lastname: Neves
authors.forename: Silvana Maria Elói
authors.initials: SM
authors.lastname: Santos
authors.forename: Marta Maria S
authors.initials: MM
authors.lastname: Sarquis
authors.forename: Paul E
authors.initials: PE
authors.lastname: Marik
authors.forename: Eduardo Pimentel
authors.initials: EP
authors.lastname: Dias
mesh_terms: D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000378:metabolism; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis* / Q000097:blood; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012463:Saliva / Q000737:chemistry*; D018805:Sepsis / Q000378:metabolism / Q000401:mortality*; D013514:Surgical Procedures, Operative
chemical_list: D015415:Biomarkers; D006854:Hydrocortisone