J Korean Med Sci.  2007 Jun;22(3):470-475. 10.3346/jkms.2007.22.3.470.

Basal Serum Cortisol Levels are not Predictive of Response to Corticotropin but Have Prognostic Significance in Patients with Septic Shock

• Kwon YS
• Suh GY
• Kang EH
• Koh WJ
• Chung MP
• Kim H
• Kwon OJ

• KMID: 1778356
• DOI: http://doi.org/10.3346/jkms.2007.22.3.470

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.

Keyword

Septic Shock; Adrenal Insufficiency; Mortality

MeSH Terms

Adrenal Insufficiency/blood/diagnosis
Adrenocorticotropic Hormone/*pharmacology
Aged
Female
Humans
Hydrocortisone/*blood
Incidence
Male
Middle Aged
Prognosis
Reference Values
Shock, Septic/*blood/*diagnosis/mortality
Time Factors
Treatment Outcome

Figure

• 

  Fig. 1 Kaplan-Meier analysis of the survival probability in patients with septic shock.

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