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

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 µg/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 (≥30 µg/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.

Differential Thermoregulatory and Inflammatory Patterns in the Circadian Response to LPS-Induced Septic Shock

“…Additionally, we analyzed corticosterone levels in serum, which can attain immunosuppressant functions (Stahn and Buttgereit, 2008;Ayroldi et al, 2012), and depend on hypothalamo-pituitary-adrenal (HPA) axis activation. Glucocorticoids were reported to be increased in the serum both of septic patients and animal models (Kwon et al, 2007;Thompson and van Eldik, 2009;Yamashita et al, 2017). In this work, we observed an induction of corticosterone in serum in response to LPS, independently of the inoculation time, suggesting that stimulation of the HPA axis overrules circadian modulation.…”

“…In addition, the levels of glucocorticoids, such as corticosterone, which have immunosuppressant functions (Stahn and Buttgereit, 2008), are increased in sepsis (Kwon et al, 2007;Yamashita et al, 2017). We found that the levels of corticosterone in serum were increased after LPS treatment, independently of inoculation time (Figure 7D, p < 0.0001).…”

Kadar Kortisol Serum sebagai Indikator Prognosis Sepsis pada Anak

“…9 Kortisol memiliki peran penting dalam menjaga tonus pembuluh darah, integritas endotel, permeabilitas vaskular, dan distribusi cairan tubuh dalam kompartemen vaskular. 5 Kami mendapatkan kadar kortisol serum dengan rentang (64,62-836,15) ng/mL dengan median kadar kortisol Penelitian yang dilakukan oleh Sam dkk, 12 pada pasien sepsis dewasa, melaporkan bahwa kadar kortisol meningkat pada sebagian besar pasien dengan septis dan kadar kortisol 1242 nmol/L (450 ng/mL) berhubungan dengan mortalitas yang tinggi. Demikian pula penelitian yang dilakukan oleh Christ-Crain dkk 13 melaporkan bahwa kadar kortisol adalah prediktor derajat keparahan dan luaran pada community-acquired pneumonia (CAP) pada pasien dewasa dengan luas area di bawah kurva ROC 0,76 (IK95% = 0,70-0,81 ) dan cut-off point optimal sebesar 960 nmol/L (347,5 ng/ mL).…”

“…4 Salah satu respon terhadap stres adalah aktivasi aksis Hypothalamic-pituitary-adrenal yang ditandai dengan peningkatan produksi kortisol serum. 4,5 Selama sepsis, mediator inflamasi yang dibawa oleh darah mencapai portal kapiler hipofisis di eminencia mediana melalui arteri hipofise anterior. Sitokin berdifusi ke dalam hipofisis karena area ini bebas dari sawar darah otak, kemudian menuju hipotalamus dan daerah otak tanpa sawar darah otak (lamina terminalis organum vasculosum, organ subfornical, organ subcomissura, area postrema, kelenjar pineal dan pleksus koroidalis).…”

“…3 Kortisol memiliki peran penting dalam memelihara tonus vaskular, integritas endotel, permebilitas vaskular, dan distribusi cairan tubuh di dalam vaskular, dan juga potensiasi aksi vasokonstriktor dari katekolamin. 5 Produksi harian dari kortisol adalah 55 μmol/L (laki-laki ) dan 44 μmol/L (perempuan) dengan kadar teringgi pada pagi hari. 3 Dalam plasma, kortisol dibawa oleh globulin pengikat kortisol dengan kapasitas 22μg/dL hingga 25μg/dL.…”