Cortisol levels and mortality in severe sepsis

Area of Science:

• Critical Care Medicine
• Endocrinology
• Sepsis Pathophysiology

Background:

• Serum cortisol levels commonly increase during critical illness, but optimal ranges in severe sepsis/septic shock remain undefined.
• Understanding cortisol dynamics is crucial for managing septic shock patients.

Purpose of the Study:

• To establish the range of serum cortisol levels in medical intensive care unit patients with severe sepsis/septic shock.
• To investigate the correlation between serum cortisol levels and mortality in this patient population.

Main Methods:

• A prospective observational study enrolled 100 medical intensive care unit patients within 48 hours of developing severe sepsis/septic shock.
• Morning serum cortisol levels and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were measured within the first 48 hours.
• Patients were categorized into four groups based on serum cortisol levels to analyze in-hospital mortality.

Main Results:

• The average APACHE II score was 23 +/- 7, with in-hospital and 90-day mortality rates of 51% and 60%, respectively.
• Patients with serum cortisol levels > or = 1242 nmol/l (n=16) exhibited significantly higher in-hospital mortality (81%) compared to other groups (P < 0.01).
• Cortisol levels < 552 nmol/l were observed in 30% of patients, with no significant increase in mortality.

Conclusions:

• Most patients with septic shock present with elevated serum cortisol levels.
• Serum cortisol levels > or = 1242 nmol/l are associated with a significantly higher risk of mortality in severe sepsis/septic shock.
• Lower cortisol levels (< 552 nmol/l) in this context do not appear to be linked to increased mortality.