Salivary cortisol estimation to assess adrenal status in children with fluid unresponsive septic shock

Area of Science:

• Pediatric Endocrinology
• Critical Care Medicine
• Septic Shock Pathophysiology

Background:

• Septic shock in children can lead to adrenal dysfunction.
• Assessing adrenal status in critically ill children presents challenges.
• Salivary cortisol offers a less invasive method for cortisol measurement.

Purpose of the Study:

• To evaluate the feasibility of salivary cortisol measurement in children with septic shock.
• To assess the prevalence of adrenal insufficiency (absolute and relative) in this population.
• To explore the correlation between adrenal status and clinical outcomes like mortality and catecholamine refractoriness.

Main Methods:

• Salivary cortisol levels were measured at baseline and after ACTH stimulation in 51 children with fluid-unresponsive septic shock.
• Basal salivary cortisol was also measured in 79 healthy children for comparison.
• Adrenal insufficiency was defined based on established salivary cortisol cutoffs.

Main Results:

• Children with septic shock had significantly higher baseline salivary cortisol levels compared to healthy children (P=0.001).
• Absolute adrenal insufficiency was diagnosed in 15.7% of patients.
• Relative adrenal insufficiency was prevalent, affecting 68.6% of all patients, particularly non-survivors and those with catecholamine-refractory shock.

Conclusions:

• Salivary cortisol estimation is a practical method for assessing adrenal function in pediatric septic shock.
• Relative adrenal insufficiency is a frequent complication in children with septic shock.
• Further research is warranted to understand the clinical implications of relative adrenal insufficiency in pediatric septic shock.