Adrenal functions in patients with sepsis^*

Abstract

The basal cortisol level and cortisol response to ACTH stimulation test were assessed in patients with sepsis, the results being compared to a control group of 30 healthy persons. The study group included 49 patients with sepsis and 30 healthy subjects as a control group. The mean age in the study group was 42.6 +/- 18.7 years and 41.4 +/- 12.1 years in the control group. Fifteen of the 49 (30.6%) patients had hospital-acquired and 34 (69.4%) patients community-acquired sepsis. Etiological agent was isolated in 35 (71.4%) patients (57.1% gram negative bacteria and 34.3% gram positive bacteria, plus 8.6% polymicrobial). Fourteen of 49 (28.6%) patients died. Mean basal cortisol level was 597.1 +/- 304.6 nmol/l (range 217.8-1667.9) in the study group and 460.2 +/- 180.8 nmol/l (range 253.6-988.9) in the control group. Mean basal cortisol level in the study group was significantly higher than that of the control group (p < 0.05). Mean basal cortisol level was found to be 725.5 +/- 448.9 nmol/l in the patients who died and 545.8 +/- 210.9 nmol/l in the patients who recovered. The difference between the two groups was found to be significant (p < 0.05). ACTH stimulation test was performed in 43 of the patients and 30 healthy subjects. Cortisol response was significantly lower (mean 277.7 +/- 216.9 nmol/l) in the patients than that detected in the control group (mean 519.6 +/- 279.2) (p < 0.001). Mean cortisol response in the patients who died was 227.2 +/- 224.5 nmol/l and 302.1 +/- 212.7 nmol/l in the patients who recovered (p > 0.05). Adrenocortical insufficiency was detected in 16.3% of the patients and 42.9% of these patients died. In conclusion, sepsis is characterized by high basal cortisol level which may show a poor prognosis and a blunted cortisol response to ACTH stimulation. A small percentage of patients with sepsis may develop adrenocortical insufficiency.

The effect of methylprednisolone on treatment in rats with induced sepsis

“…In a study performed by Aygen et al [26], adrenal insufficiency was observed to develop in patients with sepsis and mortality was high (42.9%) in these cases. Schumer et al [27] have shown that mortality decreases significantly enough in patients with sepsis where 30 mg/ kg MP or 3 mg/kg dexamethasone was used in comparison to a placebo.…”

“…In two studies performed on patients with septic shock, 50 mg hydrocortisone was given intravenously together with catecholamines, and a significant increase was observed in the patient's blood pressure [33,34]. According to the results of a study McKee et al [26] performed in 133 intensive care unit patients, only one of the eight patients that were given hydrocortisone (13%) died, whereas nine died out of the ten patients who had not been given steroids (90%). It was derived that adrenal insufficiency developed frequently in intensive care unit patients, and that steroid treatment at physiological doses could decrease mortality rates in these patients.…”

Can Acute Adrenal Insufficiency Be Diagnosed in the Intensive Care Unit? If So, How Should It Be Managed?

“…This is typified by a depressed cortisol response to the ACTH stimulation test. 36 This sepsis-associated AI is associated with increased mortality. 36 It has been proposed that an unstimulated cortisol level of less than 15 mg/dL (414 nmol/L) represents relative AI.…”

Systemic illness

“…They range from 276 nmol/l (10 lg/l) to 935 nmol/l (34 lg/dl), depending on the degree and chronicity of the critical illness [14,16,[23][24][25][26] and surgical stress [16,21,23,24,27,28]. However, most Authors believe that the 15 lg/dl threshold level best identifies critically ill patients with adrenal insufficiency or those who would benefit from corticosteroid replacement [11].…”