Tuberc Respir Dis.  2006 Oct;61(4):356-365.

Significance of Corticosteroids and Their Relationship with Other Parameters in Patients with Sepsis

• Lee KS
• Baik SH
• Lee HN
• Park JH
• Oh YJ
• Sheen SS
• Choi YH
• Park KJ
• Hwang SC

Abstract

BACKGROUND: Corticosteroids are known to be significant prognostic parameters in sepsis. Recently, an absolute and relative insufficiency of the corticosteroids system has often been reported to often develop particularly in severe sepsis. Degree of such an adrenal insufficiency not only has prognostic implications but also can be used to guide corticosteroids replacement therapy. The 24-hour urinary cortisol levels as well as serum cortisol concentrations were measured to assess the clinical significance and their relationship with the other parameters of sepsis, and also evaluated the clinical implications of the relative adrenal insufficiency.
METHODS
26 consecutive patients with sepsis were enrolled. The basal random serum cortisol, ACTH, ADH, lactate levels and 24-hour urinary free cortisol amount were measured. The rapid ACTH (250 microgram) stimulation test was also performed.
RESULTS
Basal serum cortisol levels were higher in the non-survivors than in the survivors. The 24-hour urinary free cortisol levels were higher in the patients with severe sepsis than in those without. The serum cortisol levels strongly correlated with the serum ADH and lactate levels. The 24-hour urinary free cortisol levels strongly correlated with the serum cortisol and lactate levels. The fractional changes in the cortisol levels after the rapid ACTH stimulation tests correlated with the serum cortisol, ADH, and lactate levels.
CONCLUSION
Both the serum cortisol and 24-hour urinary cortisol were found to be significant prognostic factors in sepsis, and showed a strong correlation with the other parameters. The relative adrenal insufficiency might also be an important clinical parameter.

Keyword

Sepsis; Corticosteroids; Cortisol; Relative adrenal insufficiency; Prognosis; Severity

MeSH Terms

Adrenal Cortex Hormones*
Adrenal Insufficiency
Adrenocorticotropic Hormone
Humans
Hydrocortisone
Lactic Acid
Prognosis
Sepsis*
Survivors
Adrenal Cortex Hormones
Adrenocorticotropic Hormone
Hydrocortisone
Lactic Acid

Figure

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  Figure 1 Comparison of serum cortisol (A) and lactate (B) levels between survivors and non-survivors in patients with sepsis.

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  Figure 2 Comparison of serum cortisol levels between survivors and non-survivors in patients with severe sepsis.

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  Figure 3 Comparison of serum cortisol (A) and lactate (B) levels between patients with mild and severe sepsis.

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  Figure 4 Comparison of 24 hour urinary free cortisol levels between patients with mild and severe sepsis.

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  Figure 5 Correlation of serum cortisol and 24 hour urinary free cortisol levels with other parameters in sepsis.

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