title: Cortisol is an associated-risk factor of brain dysfunction in patients with severe sepsis and septic shock.
abstract: OBJECTIVE
  To investigate cortisol levels in brain dysfunction in patients with severe sepsis and septic shock.
  
  
  METHODS
  In 128 septic and sedated patients, we studied brain dysfunction including delirium and coma by the evaluation of Richmond Agitation Sedation Scale (RASS), the Confusion Method Assessment in the ICU (CAM-ICU) after sedation withdrawal and the measurement of serum S100B biomarker of brain injury. Serum cortisol and S100B were measured within 12 hours after ICU admission and daily over the next four days.
  
  
  RESULTS
  Brain dysfunction was observed in 50% (64/128) before but in 84% (107/128) of patients after sedation withdrawal, and was more common in the patients older than 57 years (P = 0.009). Both cortisol (P = 0.007) and S100B levels (P = 0.028) were higher in patients with than patients without brain dysfunction. Cortisol levels were associated with ICU mortality (hazard ratio = 1.17, P = 0.024). Multivariate logistic regression showed that cortisol (odds ratio (OR): 2.34, 95% CI (2.01, 3.22), P = 0.02) and the combination effect of cortisol with age (OR: 1.004, 95% CI (1.002, 1.93), P = 0.038) but not S100B were associated with brain dysfunction.
  
  
  CONCLUSIONS
  Cortisol was an associated-risk factor of brain dysfunction in patients with severe sepsis and septic shock.
authors.affiliation: Department of Critical Care Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Duc Nam
authors.initials: DN
authors.lastname: Nguyen
authors.affiliation: Department of Critical Care Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Huyghens
authors.affiliation: Department of Anesthesia and Critical Care Medicine and Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Bond Street 30, Toronto, ON, Canada M5B 1W8.
authors.forename: Haibo
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Immunochemistry, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Schiettecatte
authors.affiliation: Department of Immunochemistry, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Smitz
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D000368:Aged; D001930:Brain Injuries / Q000097:blood / Q000150:complications / Q000473:pathology; D003128:Coma / Q000097:blood / Q000150:complications / Q000473:pathology; D016292:Procedural Sedation; D003693:Delirium / Q000097:blood / Q000150:complications / Q000473:pathology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D064568:S100 Calcium Binding Protein beta Subunit / Q000097:blood; D018805:Sepsis / Q000097:blood* / Q000150:complications / Q000473:pathology; D012772:Shock, Septic / Q000097:blood* / Q000150:complications / Q000473:pathology
chemical_list: D064568:S100 Calcium Binding Protein beta Subunit; C579160:S100B protein, human; D006854:Hydrocortisone