Kadar Kortisol Serum sebagai Indikator Prognosis Sepsis pada Anak

Abstract

Latar belakang. Salah satu respon utama terhadap stres adalah aktivasi aksis hipotalamus-hipofisis-adrenal, diketahui denganpeningkatkan produksi kortisol.Tujuan. Membuktikan kadar kortisol dapat digunakan sebagai prediktor luaran sepsis.Metode. Penelitian prospektif, dilakukan di RSUP Dr. Kariadi Semarang. Sepsis didiagnosis menurut Konsensus Konfrensi Sepsispada Anak tahun 2005, dikelompokkan sebagai luaran perbaikan dan perburukan. Kortisol serum dianalisis dengan metode ELISA.Uji Mann-Whitney U digunakan untuk menganalisis perbedaan kadar kortisol pada luaran sepsis anak. Kadar kortisol dianalisislebih lanjut menggunakan ROC dan ditentukan titik potong yang optimal.Hasil. Sejumlah 30 anak dengan diagnosis sepsis diikutsertakan dalam penelitian. Kadar kortisol serum subyek berkisar 64,62 – 836,15ng/mL, menunjukkan peningkatan (normal 24 – 229) ng/mL. Median kadar kortisol pada luaran perbaikan 187,05 (64,62-509,08)ng/mL dan pada luaran perburukan 740,91 (299,45-836,15) ng/mL. Terdapat perbedaan bermakna kadar kortisol serum pada luaranperbaikan dan luaran perburukan (p<0,001). Luas area di bawah kurva ROC 0,958, dengan titik potong kadar kortisol 323 ng/mL,RR 48,0 (IK95%:4,304–535,256; p<0,001)Kesimpulan. Kadar serum kortisol lebih dari 323 ng/mL merupakan prediktor luaran perburukan pada sepsis anak.

Cortisol levels associated with mortality in children with critical illness: a systematic review

“…A total of 21 observational studies published before 2022 were analyzed, with a total of 2,212 enrolled subjects, of whom 57.97% were male and 42.03% were female. 5,6,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] The sample consisted of 1,810 subjects with critical illness, including 916 subjects with sepsis and septic shock, and 402 control subjects. The characteristics and outcomes of included studies are shown in Tables 1 and 2, respectively.…”

“…Nineteen of 21 studies stated that there was a relationship between elevated cortisol levels and mortality in critical illness patients, including those with sepsis, as shown in Table 3. 5,6,[13][14][15][16][17][19][20][21][22][24][25][26][27][28][29][30] One study agreed with the statement, but found no relationship between postserum ACTH stimulation test and mortality in critical illness patients. 17 Fourteen studies had mortality percentage data critical illness patients with elevated cortisol levels.…”

“…17 Fourteen studies had mortality percentage data critical illness patients with elevated cortisol levels. 5,6,[13][14][15][16][17][18][19][20][25][26][27] Descriptive analysis on these 14 studies revealed a median mortality of 25.81 (range 2.7-60)% in critical illness patients. Only 7 studies had mortality rates of sepsis and septic shock patients with elevated cortisol levels.…”

“…Only 7 studies had mortality rates of sepsis and septic shock patients with elevated cortisol levels. 6,13,17,[25][26][27][28][29] The median mortality was 35.31 (range 6-60)% in sepsis/septic shock patients.…”

“…5 There was a positive correlation between serum cortisol levels and the PRISM-III score. 6 Serum total cortisol and free cortisol were associated with disease severity as measured by the PRISM-III score. 7 On the other hand, CIRCI is defined as insufficient cellular corticosteroid activity based on the severity of the patient's disease.…”