Poster presentation | Open | Published:
Clinical study on the relationship of adrenal function and prognosis in patients with severe sepsis
Critical Carevolume 10, Article number: P264 (2006)
To explore the relationship of adrenal function and prognosis in patients with severe sepsis.
A prospective study between July and December 2004 in six teaching hospitals. Two hundred and forty patients with severe sepsis were enrolled in this study. A short corticotropin stimulation test was performed in all patients by intravenously injecting 250 μg corticotropin. Blood samples were taken immediately before the test (T0) and 30 min (T30) and 60 min (T60) afterward, and the plasma cortisol concentration was measured by radioimmunoassay. At the onset of severe sepsis, the following parameters were recorded: age, sex, APACHE II, heart rate, mean arterial pressure, PaO2/FiO2, arterial pH, peripheral blood of hemoglobin, platelets and leukocyte concentration, and the number of organ failures. Patients were divided into two groups (survival and nonsurvival group) according to the 28-day mortality. Relative adrenal insufficiency was defined as the difference between T0 and the higher value between T30 or T60 (DTmax) < 9 μg/dl.
The 28-day mortality was 44.17%, and the rate of relative adrenal insufficiency was 38.33%. Between the survival group and nonsurvival group, the age, APACHE II, arterial pH, peripheral blood of platelets, the number of organ failures, and T0 and DTmax showed a significant difference. The mean T0 was 29.22 μg/dl, a value of T0 lower than 29.22 μg/dl showed good outcome, and the area under the ROC curve was 0.72. Using the reference value of DTmax < 9 μg/dl, DTmax higher than 9 μg/dl was significantly associated with death rates, and the area under the ROC curve was 0.72. Three groups of patient prognoses were identified: good (cortisol level at T0 < 29.22 μg/dl and DTmax > 9 μg/dl, 28-day mortality rate 18.37%); intermediate (T0 > 29.22 μg/dl and DTmax > 9 μg/dl or T0 < 29.22 μg/dl and DTmax < 9 μg/dl, 28-day mortality rate 45.24%); and poor (T0 > 29.22 μg/dl and DTmax < 9 μg/dl, 28-day mortality rate 86.21%).
The base cortisol level and a short corticotropin stimulation test had a good prognostic value for severe sepsis.