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Critical Care

Volume 12 Supplement 5

Sepsis 2008

Open Access

Eosinophilia as a marker of adrenal insufficiency in critically ill patients with severe septic shock: 1-year prospective study

  • Eleni Mouloudi1,
  • Constantine Katsanoulas1,
  • Dionysios Vrochides1,
  • Tatiana Giasnetsova1,
  • Chryssoula Papageorghiou1 and
  • Nikoletta Gritsi-Gerogianni1
Critical Care200812(Suppl 5):P9

https://doi.org/10.1186/cc7042

Published: 18 November 2008

Keywords

Septic ShockEosinophiliaAdrenal InsufficiencyCortisol ConcentrationChronic Health Evaluation

Background

Adequate adrenocortical function is essential to survive critical illness. The number of circulating eosinophils has been proposed as a marker of adrenocortical function. The goal of the present study was to determine whether eosinophilia could serve as a useful and early marker of adrenal insufficiency in critically ill patients with severe septic shock.

Methods

During a 1-year period, we studied prospectively all 294 patients admitted to our ICU. Sixteen patients (13 male/three female, 5.4% of admissions) with eosinophilia defined as more than 3% of the white blood cell count and severe septic shock, refractory to fluid and vasopressor resuscitation, were included. A high-dose (250 μg, intravenously) corticotropin stimulation test was performed in all included patients.

Results

The mean age was 47.2 ± 18.7 years, the Acute Physiology and Chronic Health Evaluation II score on admission day was 18.6 ± 6.8 and the Sepsis-related Organ Failure Assessment score was 10.3 ± 2.7 on eosinophilia day. The mean eosinophil count was 6.9 ± 3.5% of white blood cells. Eosinophilia was present 1.9 ± 0.9 days (range 8 hours to 4 days) before the onset of septic shock. Multidrug-resistant Gram-negative bacteria in 14 patients, Gram-positive in three patients and fungi in two patients were isolated and considered responsible for sepsis. Baseline cortisol levels were 19.4 ± 8.1 μg/dl and the adrenal response to the corticotropin stimulation test was 8.3 ± 4.9 μg/dl above baseline. Eleven out of 16 patients failed to respond to the corticotropin stimulation test above the critical level of a 9 μg/dl rise, and two out of 16 patients had baseline cortisol concentration <10 μg/dl. A hydrocortisone infusion (300 mg/day) treatment resulted in haemodynamic improvement in 12 out of 16 patients (75%). The 28-day mortality (following the onset of septic shock) was 43.7%. The only independent predictor of death was age (P = 0.027).

Conclusion

Relative eosinophilia may be considered a useful and early bioassay for adrenocortical function assessment in critically ill patients with severe septic shock and assumed adrenocortical depression.

Authors’ Affiliations

(1)
Intensive Care Unit Department, Hippokrateion Hospital, Thessaloniki, Greece

Copyright

© Mouloudi et al; licensee BioMed Central Ltd. 2008

This article is published under license to BioMed Central Ltd.

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