Prognostic Value of Cortisol Response in Septic Shock

Effects of etomidate on complications related to intubation and on mortality in septic shock patients treated with hydrocortisone: a propensity score analysis

“…The higher rate of CIRCI when patients received etomidate may explain the higher cumulative dose of hydrocortisone because, in the present study, hydrocortisone was tapered and stopped according to the reversal of shock. CIRCI is associated with increased morbidity and mortality in septic shock patients [8,13,14,22]. However, despite a higher rate of CIRCI, we showed that etomidate was a protective factor for mortality in both unmatched and matched cohorts (Figure 2).…”

“…This inhibition is associated with a risk of reversible failure of the adrenal axis, which can lead to critical illness-related corticosteroid insufficiency (CIRCI) [12]. Because CIRCI is associated with an increased mortality in septic shock patients [8,13-15], etomidate use is controversial in this setting [16-19]. Moreover, some studies suggest a link between etomidate and poor outcome [11,13,14,20-22] but others failed to confirm this link [6,23-25].…”

Corticosteroids in Sepsis: Pathophysiological Rationale and the Selection of Patients

“…Low levels of cortisol were widely demonstrated in septic patients [88][89][90][91]. Low levels of cortisol were widely demonstrated in septic patients [88][89][90][91].…”

Comparison of total, salivary and calculated free cortisol levels in patients with severe sepsis

“…Cortisol response to such an illness is one of the factors that determines survival [2]. Lower or higher levels of serum total cortisol (STC) levels than expected were reported to be closely related to survival status [3]. As a kind of critical illness, sepsis may lead to major changes in hypothalamo-pituitary-adrenal (HPA) axis that causes challenges in the evaluation of its functions in those patients [4, 5].…”

“…Relative adrenal insufficiency (RAI), or critical illness-related corticosteroid insufficiency (CIRCI), is a form of adrenal insufficiency (AI) in critically ill patients whose cortisol levels are inadequate for the severe stress response they experience [6]. The diagnosis of CIRCI and the indications for corticosteroid therapy in critical illness (CI) are still controversial [3, 6–10]. Baseline or random STC levels, cortisol increment after adrenocorticotrophic hormone (ACTH) stimulation test (delta cortisol), free cortisol (FC) levels, or other markers presenting FC, or a combination of these tests have been proposed as diagnostic tests for CIRCI [4, 8–11].…”