Baseline cortisol levels, cortisol response to corticotropin, and prognosis in late septic shock

Shock. 2003 Jan;19(1):13-5. doi: 10.1097/00024382-200301000-00003.

Abstract

The prognostic value of basal and corticotropin-stimulated cortisol concentration in patients with sepsis remains a controversial issue. In a retrospective cohort study, 82 consecutive patients with septic shock underwent a short corticotropin test performed more than 24 h after the onset of vasopressor therapy. Forty-one (50%) patients died within 28 days after the onset of septic shock. The mean (SD) basal cortisol level was 22.7 (10.6) microg/dL. With threshold values of 7 and 9 microg/dL maximal increases in cortisol level, 28 (34%) and 31 (38%) patients were, respectively, classified as nonresponders to the short corticotropin test. On multivariate analysis, a cortisol level >20 microg/dL (P = 0.0002), a maximal response to corticotropin <9 microg/dL (P = 0.044), abnormal lactate values (P = 0.0098), and positive blood cultures (P = 0.004) were independent predictors of 28-day mortality. In conclusion, high basal cortisol and low increase on corticotropin stimulation are predictors of a poor outcome in late septic shock. The underlying mechanisms of these prognostic patterns remain to be elucidated.

MeSH terms

  • Adrenocorticotropic Hormone / pharmacology*
  • Adult
  • Aged
  • Aged, 80 and over
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Hydrocortisone / blood*
  • Hydrocortisone / deficiency*
  • Male
  • Middle Aged
  • Prognosis
  • Regression Analysis
  • Shock, Septic / metabolism*
  • Shock, Septic / microbiology
  • Shock, Septic / mortality
  • Time Factors

Substances

  • Adrenocorticotropic Hormone
  • Hydrocortisone