Cortisol levels fail to predict hemodynamic response to steroids and outcome in patients with septic shock

Background

Corticosteroid supplementation based on cortisol measurements was recently reported to decrease mortality in vaso-pressor-dependent septic shock patients and to predict hemo-dynamic response to corticosteroids. However, the prognostic value and clinical significance of basal cortisol levels remains controversial.

Objective

To correlate basal cortisol levels with hemodynamic response to corticosteroids and hospital mortality in patients with septic shock

Design

A prospective cohort study in a 19-bed medico-surgical ICU in a private hospital.

Patients

All 24 patients admitted with septic shock with basal cortisol concentration measured, who received hydrocortisone as part of the treatment of septic shock.

Measurements and results

Five hundred and twenty-seven patients were admitted to our ICU from September to November 2005; 24 (4.5%) were diagnosed with septic shock. After measuring a basal cortisol level, we started intravenous hydro-cortisone, 50 mg every 6 hours. The patients were divided into two groups; those with hemodynamic response (HR+) to cortico-steroids, defined as the reduction in noradrenaline dose greater than 50% in the next 24 hours, and those with no response to steroids (HR-). The mean age was 65 ± 15.75 years, and 58.3% were male. The mean cortisol level was 32.29 ± 13.7 μg/dl. Nine patients (37.5%) showed HR+ and seven (29.2%) patients died. APACHE II scores were similar in the HR+ and HR- groups, 21.33 ± 11.68 and 22.53 ± 11.39(P = NS), respectively. The mean cortisol basal level was 27.67 ± 13.75 μg/dl in the HR+ group and 35.06 ± 14.63 μg/dl in the HR- group (P = 0.159). Cortisol did not differ between survivors and nonsurvivors, 31.9 ± 12.9 and 33.2 ± 16.4 (P = 0.7), respectively. There was also no correlation between hemodynamic response and survival.

Conclusion

In this small cohort, cortisol basal levels were not able to predict hemodynamic response to hydrocortisone in septic shock patients or to differentiate survivors from nonsurvivors.